Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 3605-11 | MS |
Y | 1223P0221X | Pediatric Dentist | PEDO-483-14 | MS |
NPI | 1063706802 |
---|---|
Provider Name | Dr. Lamonica Davis Taylor |
First Address | Jackson, MS 39206-2034 |
Second Address | Jackson, MS 39206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2011 |
Last Update Date | 12/01/2016 |