Healthcare Provider Details

I. General information

NPI: 1629189303
Provider Name (Legal Business Name): TAYLOR P MCGUIRE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 UNION AVE
MEMPHIS TN
38163-1935
US

IV. Provider business mailing address

875 UNION AVE
MEMPHIS TN
38163-1935
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-6233
  • Fax: 901-448-5480
Mailing address:
  • Phone: 901-448-6233
  • Fax: 901-448-5480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberPRV-FP-096-06
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: