Provider Demographics
NPI:1447358163
Name:TAYLOR, KEITH ALLEN (DDS)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:ALLEN
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 1:110 BANKS DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-1514
Mailing Address - Country:US
Mailing Address - Phone:919-942-5652
Mailing Address - Fax:919-932-7337
Practice Address - Street 1:110 BANKS DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1514
Practice Address - Country:US
Practice Address - Phone:919-942-5652
Practice Address - Fax:919-932-7337
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC53711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice