Healthcare Provider Details

I. General information

NPI: 1326619594
Provider Name (Legal Business Name): TAYLOR EDWARD MCGREEVEY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5577 US HIGHWAY 93 N
FLORENCE MT
59833-6845
US

IV. Provider business mailing address

1201 SW HIGGINS AVE APT L
MISSOULA MT
59803-3603
US

V. Phone/Fax

Practice location:
  • Phone: 406-273-2015
  • Fax:
Mailing address:
  • Phone: 406-546-1932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN-DEN-LIC-21457
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: