Provider Demographics
NPI:1871573402
Name:TAYLOR, RYAN C (DDS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:C
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 1:250 MAKALAPA DR
Mailing Address - Street 2:
Mailing Address - City:PEARL HARBOR
Mailing Address - State:HI
Mailing Address - Zip Code:96860-3131
Mailing Address - Country:US
Mailing Address - Phone:808-471-2463
Mailing Address - Fax:
Practice Address - Street 1:1577 DEWAR DR STE 112
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5716
Practice Address - Country:US
Practice Address - Phone:307-382-2707
Practice Address - Fax:307-209-9706
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-01682122300000X
UT10464104-99211223G0001X
WY11521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist