Healthcare Provider Details

I. General information

NPI: 1851846406
Provider Name (Legal Business Name): LEVI TAYLOR D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 KINGS CT
KAYSVILLE UT
84037-9548
US

IV. Provider business mailing address

1126 KINGS CT
KAYSVILLE UT
84037-9548
US

V. Phone/Fax

Practice location:
  • Phone: 801-201-3037
  • Fax:
Mailing address:
  • Phone: 801-201-3037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number9899249-9924
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: