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General NPI Number Information
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NPI Number | 1235616657
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Entity Type | Individual
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Provider Name | KYLE TAYLOR
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Gender | Male
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Dates
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Enumeration Date | 07/27/2018
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Last Update Date | 07/27/2018
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Provider Practice Location Address
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Address Line | 3504 SECOR RD STE 330
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City | TOLEDO
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State | OH
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Zip | 43606-1545
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Country | US
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Telephone | 419-534-3005
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Fax |
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Provider Business Mailing Address
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Address Line | 2603 OAK VALLEY DR APT 202
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City | ANN ARBOR
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State | MI
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Zip | 48103-7703
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Country | US
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Telephone |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2901022694
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License Number State | MI
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