Individual
MCKENZIE CAROLINE TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 JOHN F KENNEDY BLVD STE 1906, PHILADELPHIA, PA 19102-1714
(215) 709-0001
Mailing address
3436 ASHVILLE ST, PHILADELPHIA, PA 19136-3020
(609) 579-0196
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS043955
PA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/28/2022
Last updated
05/23/2023
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