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General NPI Number Information
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NPI Number | 1598879975
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Entity Type | Individual
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Provider Name | BOBBY NEIL TAYLOR I D.D.S
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Gender | Male
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4208 MAPLE AVE
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City | ODESSA
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State | TX
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Zip | 79762-7152
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Country | US
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Telephone | 432-367-4774
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 E 17TH ST
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City | ODESSA
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State | TX
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Zip | 79761-1808
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Country | US
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Telephone | 432-367-8030
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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 | 10173
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License Number State | TX
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