MEDICARE: KYLE TAYLOR

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	2901022694	MI

General Provider Information

NPI Number	:	1235616657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE TAYLOR

Provider Business Mailing Address
First Line	:	2603 OAK VALLEY DR APT 202
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-7703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3504 SECOR RD STE 330
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-1545
Country	:	US
Telephone Number	:	419-534-3005
Fax Number	:

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

Provider Enumeration Date	:	07/27/2018
Last Update Date	:	07/27/2018

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Directions to “ KYLE TAYLOR ” Practice Location

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