Healthcare Provider Details

I. General information

NPI: 1174603195
Provider Name (Legal Business Name): H DIXON TAYLOR DDS A PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 COWELL ROAD
CONCORD CA
94518-1903
US

IV. Provider business mailing address

4501 COWELL ROAD
CONCORD CA
94518-1903
US

V. Phone/Fax

Practice location:
  • Phone: 925-689-9350
  • Fax: 925-689-3445
Mailing address:
  • Phone: 925-689-9350
  • Fax: 925-689-3445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number32910
License Number StateCA

VIII. Authorized Official

Name: DR. H DIXON TAYLOR III
Title or Position: PRES
Credential: DDS MDS
Phone: 925-689-9350