Healthcare Provider Details

I. General information

NPI: 1548107519
Provider Name (Legal Business Name): TAYLOR CARROLL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 MEDWAY RD STE 2&3
MILFORD MA
01757-2932
US

IV. Provider business mailing address

8860 BRACKEN WAY
FORT MYERS FL
33908-3631
US

V. Phone/Fax

Practice location:
  • Phone: 781-325-1091
  • Fax:
Mailing address:
  • Phone: 239-839-1206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: