Individual
JENNIFER LYNN TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
7524 S ANTHONY BLVD, FORT WAYNE, IN 46816-2517
(260) 441-8500
Mailing address
7524 S ANTHONY BLVD, FORT WAYNE, IN 46816-2523
(260) 441-8500
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12010849A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201238440A
—
IN
Enumeration date
10/12/2006
Last updated
03/20/2019
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