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General NPI Number Information
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NPI Number | 1255909750
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Entity Type | Individual
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Provider Name | TAYLOR RICHARD HAMMOCK DMD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2021
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 255 SE 14TH ST STE 1A
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-1852
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Country | US
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Telephone | 954-523-6525
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Fax |
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Provider Business Mailing Address
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Address Line | 17945 SW 97TH AVE APT 140
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City | PALMETTO BAY
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State | FL
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Zip | 33157-5425
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Country | US
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Telephone | 843-902-8518
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 25828
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License Number State | FL
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