Provider Demographics
NPI:1992924963
Name:TAYLOR BROOK DENTAL ASSOCIATES
Entity type:Organization
Organization Name:TAYLOR BROOK DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:B
Authorized Official - Last Name:LARLEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-784-1577
Mailing Address - Street 1:27 MILLETT DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-4055
Mailing Address - Country:US
Mailing Address - Phone:207-784-1577
Mailing Address - Fax:207-786-5214
Practice Address - Street 1:27 MILLETT DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-4055
Practice Address - Country:US
Practice Address - Phone:207-784-1577
Practice Address - Fax:207-786-5214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty