Provider Demographics
NPI:1104569540
Name:SCOTT W. TAYLOR D.D.S, P.C.
Entity type:Organization
Organization Name:SCOTT W. TAYLOR D.D.S, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRYSTA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-228-6309
Mailing Address - Street 1:1055 W FAIR AVE
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2665
Mailing Address - Country:US
Mailing Address - Phone:906-228-6309
Mailing Address - Fax:906-264-5007
Practice Address - Street 1:1055 W FAIR AVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2665
Practice Address - Country:US
Practice Address - Phone:906-228-6309
Practice Address - Fax:906-264-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental