Healthcare Provider Details

I. General information

NPI: 1235055120
Provider Name (Legal Business Name): TAYLOR MICHELLE ISAAK DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12528 OLIVE BLVD STE F
SAINT LOUIS MO
63141-6365
US

IV. Provider business mailing address

539 SARAH LN APT F
SAINT LOUIS MO
63141-6986
US

V. Phone/Fax

Practice location:
  • Phone: 314-936-2185
  • Fax:
Mailing address:
  • Phone: 618-918-1459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2026027800
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: