Individual
DR. BRENDA JEAN TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
701 WEST 111TH STREET, CHICAGO, IL 60628
(773) 995-1234
(773) 995-9796
Mailing address
11139 S HALSTED ST, CHICAGO, IL 60628-3910
(773) 995-1234
(773) 995-9796
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019-023707
IL
1223G0001X
General Practice Dentistry
Primary
019023707
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200248120
—
IN
Enumeration date
10/13/2006
Last updated
04/30/2021
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