Healthcare Provider Details

I. General information

NPI: 1902823404
Provider Name (Legal Business Name): STEVEN EDWIN TAYLOR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 ANNAPOLIS ROAD SUITE 101
ODENTON MD
21113
US

IV. Provider business mailing address

1413 ANNAPOLIS ROAD SUITE 101
ODENTON MD
21113
US

V. Phone/Fax

Practice location:
  • Phone: 410-674-5233
  • Fax: 410-674-3174
Mailing address:
  • Phone: 410-674-5233
  • Fax: 410-674-5233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number10699
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: