Provider Demographics
NPI:1174715510
Name:TAYLOR, JUANITA R (DDS)
Entity type:Individual
Prefix:DR
First Name:JUANITA
Middle Name:R
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 LAFAYETTE RD STE B
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-2035
Mailing Address - Country:US
Mailing Address - Phone:317-968-9700
Mailing Address - Fax:
Practice Address - Street 1:4615 LAFAYETTE RD
Practice Address - Street 2:SUITE B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-2035
Practice Address - Country:US
Practice Address - Phone:317-968-9700
Practice Address - Fax:317-968-9701
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011023A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist