Provider Demographics
NPI:1932218575
Name:TAYLOR, KERRY LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:LYNN
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 1:855 E WARNER RD
Mailing Address - Street 2:#104
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-0997
Mailing Address - Country:US
Mailing Address - Phone:480-786-1734
Mailing Address - Fax:480-899-5851
Practice Address - Street 1:855 E WARNER RD
Practice Address - Street 2:#104
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-0997
Practice Address - Country:US
Practice Address - Phone:480-786-1734
Practice Address - Fax:480-899-5851
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3143122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist