MEDICARE: DR. TAYLOR ANNAS 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	1223G0001X	General Practice Dentistry	D012247	AZ

General Provider Information

NPI Number	:	1376388850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAYLOR ANNAS DMD

Provider Business Mailing Address
First Line	:	2065 CLEARWOOD CT
Second Line	:
City	:	SHELBY TWP
State	:	MI
Zip	:	48316-1015
Country	:	US
Telephone Number	:	586-850-8438
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 E BELL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2211
Country	:	US
Telephone Number	:	480-605-3666
Fax Number	:

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

Provider Enumeration Date	:	06/27/2024
Last Update Date	:	06/27/2024

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