MEDICARE: ZACHARY TAYLOR DDS PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1467029736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZACHARY TAYLOR DDS PLLC

Provider Business Mailing Address
First Line	:	4868 N ELENA MARIA PL
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-6758
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4266 N EAGLE RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83713-0726
Country	:	US
Telephone Number	:	208-939-7053
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ZACHARY TUTTLE TAYLOR
Credential	:	DDS
Telephone Number	:	801-792-4291

Provider Enumeration Date	:	06/07/2021
Last Update Date	:	06/07/2021

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