Healthcare Provider Details

I. General information

NPI: 1902917685
Provider Name (Legal Business Name): STEVEN E TAYLOR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 FORUM BLVD SUITE 12
COLUMBIA MO
65203-1997
US

IV. Provider business mailing address

1100 CLUB VILLAGE DRIVE SUITE 103
COLUMBIA MO
65203
US

V. Phone/Fax

Practice location:
  • Phone: 573-446-7259
  • Fax:
Mailing address:
  • Phone: 573-446-7259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2001032600
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: