Provider Demographics
NPI:1073676896
Name:STEPHEN A TAYLOR,DDS,INC
Entity Type:Organization
Organization Name:STEPHEN A TAYLOR,DDS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-885-3173
Mailing Address - Street 1:1300 LINCOLN WAY STE C
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-5007
Mailing Address - Country:US
Mailing Address - Phone:530-885-3173
Mailing Address - Fax:530-889-8528
Practice Address - Street 1:1300 LINCOLN WAY STE C
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5007
Practice Address - Country:US
Practice Address - Phone:530-885-3173
Practice Address - Fax:530-889-8528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA237681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB2376802Medicaid