Provider Demographics
NPI:1194839019
Name:TAYLOR, ROBERT MALCOLM III (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MALCOLM
Last Name:TAYLOR
Suffix:III
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 1:1610 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-3380
Mailing Address - Country:US
Mailing Address - Phone:989-684-9110
Mailing Address - Fax:989-684-2812
Practice Address - Street 1:1610 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-3380
Practice Address - Country:US
Practice Address - Phone:989-684-9110
Practice Address - Fax:989-684-2812
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010182691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice