Provider Demographics
NPI:1033695010
Name:WILSON, TARYN (DMD)
Entity type:Individual
Prefix:DR
First Name:TARYN
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3684 HIGHWAY 150 STE 9
Mailing Address - Street 2:
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-9692
Mailing Address - Country:US
Mailing Address - Phone:812-923-1400
Mailing Address - Fax:812-923-8510
Practice Address - Street 1:3684 HIGHWAY 150 STE 9
Practice Address - Street 2:
Practice Address - City:FLOYDS KNOBS
Practice Address - State:IN
Practice Address - Zip Code:47119-9692
Practice Address - Country:US
Practice Address - Phone:812-923-1400
Practice Address - Fax:812-923-8510
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101441223G0001X
IN12013439A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice