MEDICARE: KRISTINA 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
1	124Q00000X	Dental Hygienist	DH6090	WA

General Provider Information

NPI Number	:	1386937332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA TAYLOR RDH

Provider Business Mailing Address
First Line	:	2312 W MAIN ST
Second Line	:	SUITE 121
City	:	BATTLE GROUND
State	:	WA
Zip	:	98604-4234
Country	:	US
Telephone Number	:	360-687-4721
Fax Number	:

Provider Business Practice Location Address
First Line	:	2312 W MAIN ST
Second Line	:	SUITE 121
City	:	BATTLE GROUND
State	:	WA
Zip	:	98604-4234
Country	:	US
Telephone Number	:	360-687-4721
Fax Number	:

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

Provider Enumeration Date	:	05/24/2011
Last Update Date	:	05/24/2011

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Directions to “ KRISTINA TAYLOR RDH” Practice Location

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