Provider Demographics
NPI:1043320617
Name:TAYLOR, JOHN L (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 554
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-0554
Mailing Address - Country:US
Mailing Address - Phone:972-564-9355
Mailing Address - Fax:972-552-1771
Practice Address - Street 1:417 N MCGRAW ST
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-8661
Practice Address - Country:US
Practice Address - Phone:972-564-9355
Practice Address - Fax:972-552-1771
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT14703122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist