Healthcare Provider Details

I. General information

NPI: 1144074121
Provider Name (Legal Business Name): TAYLOR JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 GUY LOMBARDO AVE
FREEPORT NY
11520-3715
US

IV. Provider business mailing address

80 GUY LOMBARDO AVE
FREEPORT NY
11520-3715
US

V. Phone/Fax

Practice location:
  • Phone: 516-223-6896
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number065035-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: