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General NPI Number Information
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NPI Number | 1093873606
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Entity Type | Organization
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Legal Business Name | LEE G TAYLOR DDS PC
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 710 DARBY ROAD
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City | HAVERTOWN
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State | PA
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Zip | 19083
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Country | US
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Telephone | 610-789-2904
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Fax | 610-789-7854
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Provider Business Mailing Address
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Address Line | 710 DARBY ROAD
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City | HAVERTOWN
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State | PA
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Zip | 19083
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Country | US
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Telephone | 610-789-2904
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Fax |
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Authorized Official
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Title or Position | PRESIDENT DENTIST
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Name | DR. LEE GIFFORD TAYLOR SR.
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Credential | DDS
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Telephone | 610-789-2904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS021471L
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License Number State | PA
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