Healthcare Provider Details

I. General information

NPI: 1003230111
Provider Name (Legal Business Name): TAYLOR DIGGS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35401 MISSION DR
SAINT IGNATIUS MT
59865-7791
US

IV. Provider business mailing address

237 SW HIGGINS AVE STE A
MISSOULA MT
59803-1485
US

V. Phone/Fax

Practice location:
  • Phone: 406-745-3525
  • Fax:
Mailing address:
  • Phone: 406-926-3488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN-DEN-LIC-6020
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: