MEDICARE: DR. TREVOR K TAYLOR DMD

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	7623	KY

General Provider Information

NPI Number	:	1194716217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TREVOR K TAYLOR DMD

Provider Business Mailing Address
First Line	:	6435 W HIGHWAY 146
Second Line	:	SUITE 1
City	:	CRESTWOOD
State	:	KY
Zip	:	40014-9575
Country	:	US
Telephone Number	:	502-241-1515
Fax Number	:	502-241-1521

Provider Business Practice Location Address
First Line	:	6435 W HIGHWAY 146
Second Line	:	SUITE 1
City	:	CRESTWOOD
State	:	KY
Zip	:	40014-9575
Country	:	US
Telephone Number	:	502-241-1515
Fax Number	:	502-241-1521

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	07/08/2007

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