Provider Demographics
NPI:1194754069
Name:TAYLOR, CHARLES D (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:D
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 1:77564 COUNTRY CLUB DRIVE STE 350
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211
Mailing Address - Country:US
Mailing Address - Phone:760-772-7082
Mailing Address - Fax:760-772-7085
Practice Address - Street 1:77564 COUNTRY CLUB DRIVE #350
Practice Address - Street 2:350
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211
Practice Address - Country:US
Practice Address - Phone:760-772-7082
Practice Address - Fax:760-772-7085
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI10953122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist