Healthcare Provider Details

I. General information

NPI: 1013678945
Provider Name (Legal Business Name): TAYLOR PAEK DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LAFAYETTE ST FL 6F
NEW YORK NY
10013-4153
US

IV. Provider business mailing address

75 MCGUINNESS BLVD APT 6B
BROOKLYN NY
11222-7852
US

V. Phone/Fax

Practice location:
  • Phone: 212-226-6368
  • Fax:
Mailing address:
  • Phone: 410-979-7535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number063677
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: