Provider Demographics
NPI:1831863240
Name:SCHNELL, TAYLOR (DMD)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:
Last Name:SCHNELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7940 SW 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-2502
Mailing Address - Country:US
Mailing Address - Phone:503-475-8252
Mailing Address - Fax:
Practice Address - Street 1:17655 SE MCLOUGHLIN BLVD STE D
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-5970
Practice Address - Country:US
Practice Address - Phone:503-659-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD114971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice