1508178898 NPI number — DR. JOHN WILLIAM TAYLOR D.D.S.

Table of content: DR. JOHN WILLIAM TAYLOR D.D.S. (NPI 1508178898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508178898 NPI number — DR. JOHN WILLIAM TAYLOR D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
JOHN
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
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:
1508178898
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4540 E. BASELINE RD.
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-830-5466
Provider Business Mailing Address Fax Number:
480-830-5577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4540 E. BASELINE RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-830-5466
Provider Business Practice Location Address Fax Number:
480-830-5577
Provider Enumeration Date:
07/02/2010

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: 1223P0221X , with the licence number:  3976-18 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223P0221X , with the licence number: 8386 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 689851 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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