Provider Demographics
NPI:1861735524
Name:TAYLOR, SARAH JOHNSON (DMD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JOHNSON
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:VIRGINIA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:414 W 120TH ST
Mailing Address - Street 2:APT. 101
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-6702
Mailing Address - Country:US
Mailing Address - Phone:864-918-8397
Mailing Address - Fax:
Practice Address - Street 1:319 6TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2905
Practice Address - Country:US
Practice Address - Phone:718-369-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057425122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist