Provider Demographics
NPI:1386937332
Name:TAYLOR, KRISTINA (RDH)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 W MAIN ST
Mailing Address - Street 2:SUITE 121
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4234
Mailing Address - Country:US
Mailing Address - Phone:360-687-4721
Mailing Address - Fax:
Practice Address - Street 1:2312 W MAIN ST
Practice Address - Street 2:SUITE 121
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-4234
Practice Address - Country:US
Practice Address - Phone:360-687-4721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH6090124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist