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General NPI Number Information
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NPI Number | 1588586994
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Entity Type | Organization
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Legal Business Name | TAYLORMADE DENTAL & IMPLANT CENTER, LLC
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Dates
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Enumeration Date | 07/28/2026
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Last Update Date | 07/28/2026
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Provider Practice Location Address
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Address Line | 3210 STONE RD STE A
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City | KILGORE
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State | TX
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Zip | 75662-2966
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Country | US
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Telephone | 903-738-1393
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Fax | 903-984-8586
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Provider Business Mailing Address
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Address Line | 3210 STONE RD STE A
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City | KILGORE
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State | TX
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Zip | 75662-2966
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Country | US
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Telephone | 903-738-1393
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Fax | 903-984-8586
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | JEREMIAH TAYLOR
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Credential | DDS
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Telephone | 903-984-8556
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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 |
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License Number State |
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