=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043320617
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN L TAYLOR DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 417 N MCGRAW ST
-----------------------------------------------------
City | FORNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75126-8661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-564-9355
-----------------------------------------------------
Fax | 972-552-1771
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 554
-----------------------------------------------------
City | FORNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75126-0554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-564-9355
-----------------------------------------------------
Fax | 972-552-1771
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | T14703
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------