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General NPI Number Information
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NPI Number | 1821127549
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Entity Type | Organization
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Legal Business Name | GLENN N TAYLOR JR DMD MD PA
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1947 CITRONA DRIVE
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034
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Country | US
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Telephone | 904-261-6068
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Fax | 904-261-9797
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Provider Business Mailing Address
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Address Line | 4202 NW 155TH TERRACE
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City | NEWBERRY
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State | FL
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Zip | 32669
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Country | US
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Telephone | 352-332-2876
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Fax | 352-332-1113
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Authorized Official
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Title or Position | ORAL SURGEON
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Name | DR. GLENN N TAYLOR JR.
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Credential | DMD MD
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Telephone | 904-261-6068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN13187
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License Number State | FL
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