Provider Demographics
NPI:1144219452
Name:TAYLOR, DARRYL LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:LYNN
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 1:1105 TEAL WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-1837
Mailing Address - Country:US
Mailing Address - Phone:760-529-9822
Mailing Address - Fax:
Practice Address - Street 1:1ST DENTAL BATTALION, NAVAL DENTAL CENTER
Practice Address - Street 2:CAMP PENDLETON MARINE BASE
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5221
Practice Address - Country:US
Practice Address - Phone:760-725-5102
Practice Address - Fax:760-725-5779
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD111421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice