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NPI Code Detail

MEDICARE: DR. TAYLOR COLLAZO

MEDICARE: DR. TAYLOR COLLAZO
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
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry30725TX
21223X0400XOrthodontics and Dentofacial Orthopedics Dentistry4020AR

General Provider Information

NPI Number : 1164800868
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TAYLOR COLLAZO
Provider Business Mailing Address
First Line : 100 E 15TH ST STE 520
Second Line :
City : FORT WORTH
State : TX
Zip : 76102-6566
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 E 15TH ST STE 520
Second Line :
City : FORT WORTH
State : TX
Zip : 76102-6566
Country : US
Telephone Number : 817-529-8151
Fax Number : 817-394-1911
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2015
Last Update Date : 05/13/2015

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Directions to “ DR. TAYLOR COLLAZO ” Practice Location

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