MEDICARE: DR. JOHNNY DEMPSEY 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	17869	TX

General Provider Information

NPI Number	:	1568528180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHNNY DEMPSEY TAYLOR DDS

Provider Business Mailing Address
First Line	:	7 SWITCHBUD PL
Second Line	:	200
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-3700
Country	:	US
Telephone Number	:	281-364-9913
Fax Number	:	281-367-8421

Provider Business Practice Location Address
First Line	:	7 SWITCHBUD PL
Second Line	:	200
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-3700
Country	:	US
Telephone Number	:	281-364-9913
Fax Number	:	281-367-8421

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/08/2007

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