Healthcare Provider Details

I. General information

NPI: 1386010049
Provider Name (Legal Business Name): TAYLOR BINGHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7918 BERKSHIRE LN
CASTLE PINES CO
80108-8853
US

IV. Provider business mailing address

1725 ANDREWS CIR
SUISUN CITY CA
94585-6300
US

V. Phone/Fax

Practice location:
  • Phone: 909-438-3287
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDEN.00205353
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number64978
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: