Individual
KELLY ELDON TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
860 S 2ND AVE, SUITE A, WALLA WALLA, WA 99362-4072
(509) 529-2000
(509) 529-4590
Mailing address
52 DONRITA CT, WALLA WALLA, WA 99362-8018
(509) 593-4739
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
D8732
OR
1223P0700X
Prosthodontics
Primary
DE00008680
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171037
—
OR
Enumeration date
05/15/2006
Last updated
05/31/2011
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