Provider Demographics
NPI:1114935590
Name:TAYLOR, D. LANCE (DMD, MS, PC)
Entity Type:Individual
Prefix:DR
First Name:D.
Middle Name:LANCE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DMD, MS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 W ILES AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-4194
Mailing Address - Country:US
Mailing Address - Phone:217-698-6150
Mailing Address - Fax:217-698-6151
Practice Address - Street 1:2050 W ILES AVE STE C
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-4194
Practice Address - Country:US
Practice Address - Phone:217-698-6150
Practice Address - Fax:217-698-6151
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021-0016931223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics