Healthcare Provider Details

I. General information

NPI: 1003358755
Provider Name (Legal Business Name): TAYLOR ZMOOS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 ELK DR STE 1
MINOT ND
58701
US

IV. Provider business mailing address

2615 ELK DR STE 1
MINOT ND
58701-1200
US

V. Phone/Fax

Practice location:
  • Phone: 701-839-4440
  • Fax: 701-839-1911
Mailing address:
  • Phone: 701-839-4440
  • Fax: 701-839-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2313
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number00202978
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1451163
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: