Healthcare Provider Details

I. General information

NPI: 1760863872
Provider Name (Legal Business Name): CAADRIAN NORMAN TAYLOR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAADRIAN NORMAN DDS

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5770 N HAMILTON RD STE A
COLUMBUS OH
43230
US

IV. Provider business mailing address

5770 N HAMILTON RD STE A
COLUMBUS OH
43230-1326
US

V. Phone/Fax

Practice location:
  • Phone: 614-475-5439
  • Fax: 614-476-8558
Mailing address:
  • Phone: 614-475-5439
  • Fax: 614-476-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number30024933
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDRP1397
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: