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NPI Code Detail

MEDICARE: KELLY J TAYLOR RDH

MEDICARE: KELLY J TAYLOR RDH
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
1124Q00000XDental Hygienist4380NV

General Provider Information

NPI Number : 1124319181
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY J TAYLOR RDH
Provider Business Mailing Address
First Line : 3074 ARVILLE ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-7490
Country : US
Telephone Number : 702-889-3763
Fax Number : 702-889-3591
Provider Business Practice Location Address
First Line : 3074 ARVILLE ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-7490
Country : US
Telephone Number : 702-889-3763
Fax Number : 702-889-3591
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2011
Last Update Date : 04/04/2013

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