Provider Demographics
NPI:1588745509
Name:TAYLOR, KENNETH ALAN (DDS)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:ALAN
Last Name:TAYLOR
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 1:610 DUPONT ST
Mailing Address - Street 2:SUITE 132
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4054
Mailing Address - Country:US
Mailing Address - Phone:360-650-1458
Mailing Address - Fax:360-650-1469
Practice Address - Street 1:610 DUPONT ST
Practice Address - Street 2:SUITE 132
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4054
Practice Address - Country:US
Practice Address - Phone:360-650-1458
Practice Address - Fax:360-650-1469
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00008941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist