Provider Demographics
NPI:1003957747
Name:TAYLOR, TERRY COOPER (DDS)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:COOPER
Last Name:TAYLOR
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 1:8216 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2749
Mailing Address - Country:US
Mailing Address - Phone:586-574-2323
Mailing Address - Fax:586-574-0723
Practice Address - Street 1:8216 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2749
Practice Address - Country:US
Practice Address - Phone:586-574-2323
Practice Address - Fax:586-574-0723
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010119341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice