Provider Demographics
NPI:1003925256
Name:MCKEWEN, TAYLOR WILSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:WILSON
Last Name:MCKEWEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 WEST FRANK
Mailing Address - Street 2:SUITE A
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904
Mailing Address - Country:US
Mailing Address - Phone:936-634-3156
Mailing Address - Fax:936-634-3246
Practice Address - Street 1:405 WEST FRANK
Practice Address - Street 2:SUITE A
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904
Practice Address - Country:US
Practice Address - Phone:936-634-3156
Practice Address - Fax:936-634-3246
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist