Usitalo, Taylor L

Usitalo, Taylor L is an individual health care provider with primary practice located at 2027 Cerrillos Rd , Santa Fe NM 87505-3269. He recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Orthodontics and Dentofacial Orthopedics. Dental Providers / Orthodontics and Dentofacial Orthopedics is his primary health care specialty. Usitalo, Taylor L can be contacted via phone (505) 820-1212.

Contact Information

Primary practice address
2027 Cerrillos Rd Santa Fe NM 87505-3269
Phone: (505) 820-1212
Fax: (505) 820-1218
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X DD0000 New Mexico
Dental Providers / Orthodontics and Dentofacial Orthopedics 1223X0400X DD0000 New Mexico
Dental Providers / Orthodontics and Dentofacial Orthopedics 1223X0400X DD4663 New Mexico

Profile Details

NPI number 1962934612
LBN Legal business name Usitalo, Taylor L
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 31st, 2017
Last updated Jul 19th, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962934612 NPPES
New Mexico MEDICAID 90050843

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