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General NPI Number Information
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NPI Number | 1740648591
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Entity Type | Organization
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Legal Business Name | AYONNA N. TAYLOR, D.D.S., A PROFESSIONAL CORP.
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Dates
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Enumeration Date | 02/08/2016
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Last Update Date | 02/08/2016
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Provider Practice Location Address
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Address Line | 645 AERICK ST STE 3
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City | INGLEWOOD
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State | CA
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Zip | 90301-4884
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Country | US
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Telephone | 323-678-4779
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Fax |
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Provider Business Mailing Address
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Address Line | 4116 W 64TH ST
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City | INGLEWOOD
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State | CA
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Zip | 90302-1406
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Country | US
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Telephone | 323-678-4779
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AYONNA TAYLOR
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Credential |
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Telephone | 323-678-4779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 47189
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License Number State | CA
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