Individual
DR. TAYLOR L USITALO
Active
Individual
DR. TAYLOR L USITALO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DD0000
NM
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
DD0000
NM
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DD4663
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
90050843
—
NM
Enumeration date
03/31/2017
Last updated
07/19/2019
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