Provider Demographics
NPI:1154913697
Name:ADDISON, TAYLOR (DDS)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:ADDISON
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 1:19 ADMIRALTY CT
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-4700
Mailing Address - Country:US
Mailing Address - Phone:504-756-4581
Mailing Address - Fax:
Practice Address - Street 1:1039 GRANT ST SE STE B11
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-2050
Practice Address - Country:US
Practice Address - Phone:704-747-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7153122300000X, 1223P0221X
GADN1229691223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist