Provider Demographics
NPI:1588153613
Name:TODD, TAYLOR DANIELLE (RDH)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:DANIELLE
Last Name:TODD
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 1:1282 MAGNUM DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-2036
Mailing Address - Country:US
Mailing Address - Phone:706-284-7843
Mailing Address - Fax:
Practice Address - Street 1:7973 W DESTINY BLVD
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5429
Practice Address - Country:US
Practice Address - Phone:270-412-6027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK148006124Q00000X
GADH043341124Q00000X
TN10359124Q00000X
GA124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK148006OtherALASKA DENTAL HYGIENE LICENSE NUMBER
GADH043341OtherGEORGIA DENTAL HYGIENE LICENSE NUMBER
TN10359OtherTENNESSEE DENTAL HYGIENE LICENSE NUMBER