Provider Demographics
NPI:1003047879
Name:TAYLOR, SCOTT M
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 MARIN ST.
Mailing Address - Street 2:SUITE 228
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360
Mailing Address - Country:US
Mailing Address - Phone:805-495-9916
Mailing Address - Fax:805-495-6117
Practice Address - Street 1:509 MARIN ST
Practice Address - Street 2:SUITE 228
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4261
Practice Address - Country:US
Practice Address - Phone:805-495-9916
Practice Address - Fax:805-495-6117
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38758122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist