Provider Demographics
NPI:1144335159
Name:DRS TAGGART AND NIQUETTE P C
Entity type:Organization
Organization Name:DRS TAGGART AND NIQUETTE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TAGGART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-924-5542
Mailing Address - Street 1:327 APACHE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412
Mailing Address - Country:US
Mailing Address - Phone:231-924-5542
Mailing Address - Fax:231-924-5826
Practice Address - Street 1:327 APACHE DRIVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412
Practice Address - Country:US
Practice Address - Phone:231-924-5542
Practice Address - Fax:231-924-5826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID141511223G0001X
MID144521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty