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NPI Code Detail

MEDICARE: DR. SHANE TRENT TAYLOR D.D.S.

MEDICARE: DR. SHANE TRENT TAYLOR D.D.S.
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
11223G0001XGeneral Practice Dentistry973448669922UT
21223G0001XGeneral Practice Dentistry4965NV

General Provider Information

NPI Number : 1437193075
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHANE TRENT TAYLOR D.D.S.
Provider Business Mailing Address
First Line : 1140 E FORT PIERCE DR N UNIT 8
Second Line :
City : SAINT GEORGE
State : UT
Zip : 84790-8855
Country : US
Telephone Number : 435-275-5000
Fax Number : 888-353-4948
Provider Business Practice Location Address
First Line : 3016 W CHARLESTON BLVD STE 145
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1964
Country : US
Telephone Number : 702-380-1212
Fax Number : 888-353-4948
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2006
Last Update Date : 04/12/2013

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