1255909750 NPI number — DR. TAYLOR RICHARD HAMMOCK DMD

Table of content: DR. TAYLOR RICHARD HAMMOCK DMD (NPI 1255909750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255909750 NPI number — DR. TAYLOR RICHARD HAMMOCK DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMMOCK
Provider First Name:
TAYLOR
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255909750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17945 SW 97TH AVE APT 140
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMETTO BAY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33157-5425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-902-8518
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 SE 14TH ST STE 1A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33316-1852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-523-6525
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  25828 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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