Provider Demographics
NPI:1316679392
Name:PORTSCHY, TAYLOR JOHN (DDS)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JOHN
Last Name:PORTSCHY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2483 POWDER SPRINGS RD SW STE A
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4573
Mailing Address - Country:US
Mailing Address - Phone:770-439-4141
Mailing Address - Fax:
Practice Address - Street 1:2483 POWDER SPRINGS RD SW STE A
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4573
Practice Address - Country:US
Practice Address - Phone:770-439-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1226791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice