Provider Demographics
NPI:1699873448
Name:TAYLOR, JOHN STEPHEN (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:STEPHEN
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 1:1910 STATE HIGHWAY 43 E
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75652-9106
Mailing Address - Country:US
Mailing Address - Phone:903-657-3139
Mailing Address - Fax:903-655-0699
Practice Address - Street 1:1910 STATE HIGHWAY 43 E
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-9106
Practice Address - Country:US
Practice Address - Phone:903-657-3139
Practice Address - Fax:903-655-0699
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD11737122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist