Healthcare Provider Details

I. General information

NPI: 1588673453
Provider Name (Legal Business Name): SCOTT HARLAN TAYLOR D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 CHURCH STREET
CHARLESTON AR
72933-0308
US

IV. Provider business mailing address

PO BOX 308
CHARLESTON AR
72933-0308
US

V. Phone/Fax

Practice location:
  • Phone: 479-965-2291
  • Fax:
Mailing address:
  • Phone: 479-965-2291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3229
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: