Healthcare Provider Details

I. General information

NPI: 1548640071
Provider Name (Legal Business Name): REBECCA TAYLOR DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8405 196TH ST SW
EDMONDS WA
98026-6313
US

IV. Provider business mailing address

8405 196TH ST SW
EDMONDS WA
98026-6313
US

V. Phone/Fax

Practice location:
  • Phone: 425-776-3352
  • Fax: 425-361-1485
Mailing address:
  • Phone: 425-776-3352
  • Fax: 425-361-1485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60402643
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. REBECCA TAYLOR
Title or Position: OWNER/DENTIST
Credential:
Phone: 425-776-3352