Provider Demographics
NPI:1023374410
Name:TAYLOR, ALAN BENTON (DDS)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:BENTON
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 1:2720 E PALMDALE BLVD
Mailing Address - Street 2:STE 131
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4930
Mailing Address - Country:US
Mailing Address - Phone:661-265-7397
Mailing Address - Fax:661-265-0443
Practice Address - Street 1:2720 E PALMDALE BLVD
Practice Address - Street 2:STE 131
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4930
Practice Address - Country:US
Practice Address - Phone:661-265-7397
Practice Address - Fax:661-265-0443
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA311771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice