Healthcare Provider Details

I. General information

NPI: 1497040729
Provider Name (Legal Business Name): TAYLOR BROWN TOHILL D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SARAHS LN
SOMERSET KY
42503-2775
US

IV. Provider business mailing address

101 SARAHS LN
SOMERSET KY
42503-2775
US

V. Phone/Fax

Practice location:
  • Phone: 606-679-4450
  • Fax:
Mailing address:
  • Phone: 606-679-4450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9014
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: