Healthcare Provider Details

I. General information

NPI: 1902005994
Provider Name (Legal Business Name): DAVID M. TAYLOR, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SILVER SPUR RD
ROLLING HILLS ESTATES CA
90274-3601
US

IV. Provider business mailing address

601 SILVER SPUR RD
ROLLING HILLS ESTATES CA
90274-3601
US

V. Phone/Fax

Practice location:
  • Phone: 310-377-4551
  • Fax: 310-541-6042
Mailing address:
  • Phone: 310-377-4551
  • Fax: 310-541-6042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number23389
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID TAYLOR
Title or Position: DDS/OWNER
Credential:
Phone: 310-377-4551