Healthcare Provider Details

I. General information

NPI: 1205765070
Provider Name (Legal Business Name): TAYLOR PETERSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 S PINE ST
STILLWATER OK
74074-4350
US

IV. Provider business mailing address

823 S PINE ST
STILLWATER OK
74074-4350
US

V. Phone/Fax

Practice location:
  • Phone: 405-372-1155
  • Fax:
Mailing address:
  • Phone: 405-372-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8213
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: