MEDICARE: BOBBY NEIL TAYLOR I 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
1	1223G0001X	General Practice Dentistry	10173	TX

General Provider Information

NPI Number	:	1598879975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOBBY NEIL TAYLOR I D.D.S

Provider Business Mailing Address
First Line	:	2900 E 17TH ST
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79761-1808
Country	:	US
Telephone Number	:	432-367-8030
Fax Number	:

Provider Business Practice Location Address
First Line	:	4208 MAPLE AVE
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79762-7152
Country	:	US
Telephone Number	:	432-367-4774
Fax Number	:

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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