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General NPI Number Information
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NPI Number | 1588035703
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Entity Type | Organization
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Legal Business Name | MARTINSVILLE PEDIATRIC DENTISTRY, L.L.C.
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Dates
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Enumeration Date | 10/14/2015
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 1690 S OHIO ST
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City | MARTINSVILLE
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State | IN
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Zip | 46151-3317
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Country | US
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Telephone | 765-342-8435
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Fax | 765-342-3561
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Provider Business Mailing Address
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Address Line | 1690 S OHIO ST
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City | MARTINSVILLE
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State | IN
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Zip | 46151-3317
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Country | US
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Telephone | 765-342-8435
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Fax | 765-342-3561
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Authorized Official
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Title or Position | OWNER/PEDIATRIC DENTIST
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Name | MR. KYLE WAYNE TAYLOR
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Credential | D.D.S.
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Telephone | 812-322-3834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 12010198
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License Number State | IN
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