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General NPI Number Information
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NPI Number | 1083308209
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Entity Type | Individual
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Provider Name | TOD CORWIN TAYSOM DMD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2023
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Last Update Date | 01/04/2025
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Provider Practice Location Address
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Address Line | 15920 S RANCHO SAHUARITA BLVD STE 100
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City | SAHUARITA
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State | AZ
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Zip | 85629-8013
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Country | US
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Telephone | 520-838-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 7813 S WALNUTVIEW DR
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City | TUCSON
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State | AZ
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Zip | 85757-0138
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Country | US
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Telephone | 480-254-8689
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D011818
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License Number State | AZ
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