Provider Demographics
NPI:1215159934
Name:TAYLOR, DAVID EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EDWARD
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 1:3973 N OAK ST
Mailing Address - Street 2:P.O. BOX 148
Mailing Address - City:METAMORA
Mailing Address - State:MI
Mailing Address - Zip Code:48455-9769
Mailing Address - Country:US
Mailing Address - Phone:810-678-2411
Mailing Address - Fax:
Practice Address - Street 1:3973 N OAK ST
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:MI
Practice Address - Zip Code:48455-9769
Practice Address - Country:US
Practice Address - Phone:810-678-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901012563122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist