MEDICARE: DR. PENNY L. TAYLOR D.M.D.,M.S.,P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	4548	AL

General Provider Information

NPI Number	:	1104996453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. PENNY L. TAYLOR D.M.D.,M.S.,P.C.

Provider Business Mailing Address
First Line	:	2514 DANVILLE RD SW
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35603-4213
Country	:	US
Telephone Number	:	256-351-1118
Fax Number	:	256-351-1142

Provider Business Practice Location Address
First Line	:	2514 DANVILLE RD SW
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35603-4213
Country	:	US
Telephone Number	:	256-351-1118
Fax Number	:	256-351-1142

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. PENNY LEE TAYLOR
Credential	:	D.M.D.,M.S.,P.C.
Telephone Number	:	256-351-1118

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	02/17/2010

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