Healthcare Provider Details

I. General information

NPI: 1932234986
Provider Name (Legal Business Name): GREGORY TAYLOR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 SHERIDAN ST STE B
HOLLYWOOD FL
33021-3553
US

IV. Provider business mailing address

4410 SHERIDAN ST STE B
HOLLYWOOD FL
33021-3553
US

V. Phone/Fax

Practice location:
  • Phone: 954-981-4896
  • Fax: 954-981-1523
Mailing address:
  • Phone: 954-981-4896
  • Fax: 954-981-1523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number0014792
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: