Healthcare Provider Details

I. General information

NPI: 1871573402
Provider Name (Legal Business Name): RYAN C. TAYLOR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1577 DEWAR DR STE 112
ROCK SPRINGS WY
82901-5716
US

IV. Provider business mailing address

250 MAKALAPA DR
PEARL HARBOR HI
96860-3131
US

V. Phone/Fax

Practice location:
  • Phone: 307-382-2707
  • Fax: 307-209-9706
Mailing address:
  • Phone: 808-471-2463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberN-01682
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10464104-9921
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1152
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: