Healthcare Provider Details

I. General information

NPI: 1124691316
Provider Name (Legal Business Name): DR. CASSIDY BROOKE TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 06/30/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 HOLIDAY HILL RD SUITE 200
MIDLAND TX
79707
US

IV. Provider business mailing address

1702 PAVILION PKWY
MIDLAND TX
79705-2437
US

V. Phone/Fax

Practice location:
  • Phone: 432-683-5313
  • Fax:
Mailing address:
  • Phone: 432-940-6953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number37643
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: