Provider Demographics
NPI:1306066618
Name:DENTAL PROFESSIONALS OF TAYLOR, P.L.L.C.
Entity type:Organization
Organization Name:DENTAL PROFESSIONALS OF TAYLOR, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-352-5244
Mailing Address - Street 1:1611 OLD GRANGER ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574
Mailing Address - Country:US
Mailing Address - Phone:512-352-5244
Mailing Address - Fax:
Practice Address - Street 1:1611 OLD GRANGER ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574
Practice Address - Country:US
Practice Address - Phone:512-352-5244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22326261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental