MEDICARE: DR. ROLAND S.E. TAYLOR DDS

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	14819	TX

General Provider Information

NPI Number	:	1417117516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROLAND S.E. TAYLOR DDS

Provider Business Mailing Address
First Line	:	412 N MAIN ST
Second Line	:	SUITE 110
City	:	EULESS
State	:	TX
Zip	:	76039-3652
Country	:	US
Telephone Number	:	817-354-4100
Fax Number	:	817-354-4164

Provider Business Practice Location Address
First Line	:	412 N MAIN ST
Second Line	:	SUITE 110
City	:	EULESS
State	:	TX
Zip	:	76039-3652
Country	:	US
Telephone Number	:	817-354-4100
Fax Number	:	817-354-4164

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

Provider Enumeration Date	:	06/11/2008
Last Update Date	:	06/11/2008

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