Healthcare Provider Details

I. General information

NPI: 1346787165
Provider Name (Legal Business Name): TAYLOR ELIZABETH LEEPER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR ELIZABETH KREBSBACH

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87106-1148
US

IV. Provider business mailing address

3410 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87106-1148
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-6921
  • Fax: 575-542-8387
Mailing address:
  • Phone: 505-265-6921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD4694
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: