Healthcare Provider Details

I. General information

NPI: 1346839123
Provider Name (Legal Business Name): TAYLOR BRETT FRANCIS DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5108 W GORE BLVD STE 4
LAWTON OK
73505-6025
US

IV. Provider business mailing address

5108 W GORE BLVD STE 4
LAWTON OK
73505-6025
US

V. Phone/Fax

Practice location:
  • Phone: 580-248-7600
  • Fax:
Mailing address:
  • Phone: 580-248-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7044
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number241
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number241
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: