Provider Demographics
NPI:1093245177
Name:GEYMAN, TAYLOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:
Last Name:GEYMAN
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 1:6503 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-8619
Mailing Address - Country:US
Mailing Address - Phone:208-267-0203
Mailing Address - Fax:208-943-3161
Practice Address - Street 1:6503 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-8619
Practice Address - Country:US
Practice Address - Phone:208-267-0203
Practice Address - Fax:208-943-3161
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-48481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice