=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770546327
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIAN TAYLOR DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2006
-----------------------------------------------------
Last Update Date | 02/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2300 FREEPORT RD FELDARELLI SQUARE, SUITE 1B
-----------------------------------------------------
City | NEW KENSINGTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15068-4669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-212-3167
-----------------------------------------------------
Fax | 724-212-3169
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2300 FREEPORT RD FELDARELLI SQUARE, SUITE 1B
-----------------------------------------------------
City | NEW KENSINGTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15068-4669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-212-3167
-----------------------------------------------------
Fax | 724-212-3169
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DS029847
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------