Individual
LISA MARIE TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
6226 14TH AVE, KENOSHA, WI 53143-4413
(262) 656-0044
Mailing address
2123 89TH PL, KENOSHA, WI 53143-6705
(706) 273-1365
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
1003804-16
WI
Other
Enumeration date
04/08/2022
Last updated
04/08/2022
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