Healthcare Provider Details

I. General information

NPI: 1043432198
Provider Name (Legal Business Name): ROSS L TAYLOR, P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7317 N.E. 141ST STREET
BOTHELL WA
98011
US

IV. Provider business mailing address

7317 N.E. 141ST STREET
BOTHELL WA
98011
US

V. Phone/Fax

Practice location:
  • Phone: 425-823-8803
  • Fax:
Mailing address:
  • Phone: 425-823-8803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDE00003239
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ROSS L TAYLOR
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 425-823-8803