Healthcare Provider Details

I. General information

NPI: 1306067178
Provider Name (Legal Business Name): ROSS L TAYLOR D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7317 NE 141ST STREET
BOTHELL WA
98011
US

IV. Provider business mailing address

7317 NE 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:
Title or Position:
Credential:
Phone: