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General NPI Number Information
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NPI Number | 1922737790
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Entity Type | Individual
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Provider Name | TAYLOR PROVOST DDS
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Gender | Female
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Dates
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Enumeration Date | 06/07/2022
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 24834 LORAIN RD
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-2048
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Country | US
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Telephone | 440-925-5255
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Fax |
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Provider Business Mailing Address
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Address Line | 240 FOX HOLLOW DR APT 200
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City | MAYFIELD HEIGHTS
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State | OH
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Zip | 44124-6104
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Country | US
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Telephone | 281-684-6539
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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 | 38613
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30.027952
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License Number State | OH
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