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General NPI Number Information
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NPI Number | 1538807094
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Entity Type | Individual
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Provider Name | TAYLOR HADDOCK DDS
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Gender | Male
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 06/21/2022
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Provider Practice Location Address
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Address Line | 3812 RIDGELAKE DR STE 300
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City | METAIRIE
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State | LA
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Zip | 70002-7233
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Country | US
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Telephone | 504-849-0190
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Fax |
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Provider Business Mailing Address
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Address Line | 1504 HOMESTEAD AVE
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City | METAIRIE
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State | LA
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Zip | 70005-1159
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Country | US
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Telephone | 318-820-1837
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7313
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License Number State | LA
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