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General NPI Number Information
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NPI Number | 1477866994
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Entity Type | Organization
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Legal Business Name | JEFFERY Y. TAYLOR, DMD, PA
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Dates
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Enumeration Date | 07/26/2010
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Last Update Date | 07/26/2010
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Provider Practice Location Address
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Address Line | 431 SECURITY SQ
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City | GULFPORT
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State | MS
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Zip | 39507-1922
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Country | US
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Telephone | 228-896-4325
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Fax | 228-896-5787
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Provider Business Mailing Address
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Address Line | 431 SECURITY SQ
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City | GULFPORT
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State | MS
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Zip | 39507-1922
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Country | US
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Telephone | 228-896-4325
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Fax | 228-896-5787
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. ELIZABETH SCHMIDT TAYLOR
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Credential | DMD
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Telephone | 228-896-4325
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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 | 2575-90
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License Number State | MS
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