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General NPI Number Information
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NPI Number | 1205810801
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Entity Type | Individual
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Provider Name | JAY STEPHEN TAYLOR DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 03/29/2018
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Provider Practice Location Address
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Address Line | 559 VINCENT ST ATTN: 21 DS/SGDA
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City | PETERSON AFB
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State | CO
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Zip | 80914-1540
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Country | US
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Telephone | 719-556-1603
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Fax |
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Provider Business Mailing Address
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Address Line | 559 VINCENT ST ATTN: 21 DS/SGDA
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City | PETERSON AFB
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State | CO
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Zip | 80914-1540
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Country | US
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Telephone | 719-556-1603
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 16796
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License Number State | TX
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