Healthcare Provider Details

I. General information

NPI: 1194716217
Provider Name (Legal Business Name): TREVOR K TAYLOR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6435 W HIGHWAY 146 SUITE 1
CRESTWOOD KY
40014-9575
US

IV. Provider business mailing address

6435 W HIGHWAY 146 SUITE 1
CRESTWOOD KY
40014-9575
US

V. Phone/Fax

Practice location:
  • Phone: 502-241-1515
  • Fax: 502-241-1521
Mailing address:
  • Phone: 502-241-1515
  • Fax: 502-241-1521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7623
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: