MEDICARE: TAYLOR MA DDS

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	122300000X	Dentist	38453	TX

General Provider Information

NPI Number	:	1114658499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR MA DDS

Provider Business Mailing Address
First Line	:	3508 MEADWAY DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-5341
Country	:	US
Telephone Number	:	832-472-6832
Fax Number	:

Provider Business Practice Location Address
First Line	:	9325 KEMPWOOD DR STE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77080-2813
Country	:	US
Telephone Number	:	713-460-9797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2022
Last Update Date	:	06/18/2022

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