MEDICARE: DR. TAYLOR AUSTIN LADD DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DEN.00206089	CO
2	1223G0001X	General Practice Dentistry	DD5464	NM
3	1223G0001X	General Practice Dentistry	DT-3163	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DD5464	OTHER	NM	NM DENTAL LICENSE NUMBER
2	DT-3163	OTHER	HI	HI DENTAL LICENSE NUMBER

General Provider Information

NPI Number	:	1023688124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAYLOR AUSTIN LADD DDS

Provider Business Mailing Address
First Line	:	2032 N KING ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96819-3458
Country	:	US
Telephone Number	:	575-312-6373
Fax Number	:

Provider Business Practice Location Address
First Line	:	2032 N KING ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96819-3458
Country	:	US
Telephone Number	:	575-312-6373
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	03/15/2025

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