MEDICARE: DR. COREY ALAN TAYLOR DDS, MD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	12757	NC
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	9785	KY

General Provider Information

NPI Number	:	1326400789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COREY ALAN TAYLOR DDS, MD

Provider Business Mailing Address
First Line	:	3111 SPRINGBANK LN STE A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-3373
Country	:	US
Telephone Number	:	704-541-3603
Fax Number	:

Provider Business Practice Location Address
First Line	:	3111 SPRINGBANK LN STE A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-3373
Country	:	US
Telephone Number	:	704-541-3603
Fax Number	:

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

Provider Enumeration Date	:	03/24/2016
Last Update Date	:	07/20/2022

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