Provider Demographics
NPI:1104058478
Name:ERIC K. TAYLOR, DDS, PC
Entity type:Organization
Organization Name:ERIC K. TAYLOR, DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PERIODONTAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:K
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-652-7300
Mailing Address - Street 1:455 S LIVERNOIS RD
Mailing Address - Street 2:B-12
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2578
Mailing Address - Country:US
Mailing Address - Phone:248-652-7300
Mailing Address - Fax:248-652-0637
Practice Address - Street 1:455 S. LIVERNOIS ROAD
Practice Address - Street 2:B-12
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307
Practice Address - Country:US
Practice Address - Phone:248-652-7300
Practice Address - Fax:248-652-0637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013877261QM2500X, 261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP00310Medicare PIN