Provider Demographics
NPI:1225332190
Name:TAYLOR, GLENN N JR (DMD MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:N
Last Name:TAYLOR
Suffix:JR
Gender:M
Credentials:DMD MD
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Mailing Address - Street 1:2121 NW 40TH TER
Mailing Address - Street 2:SUITE C
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-5813
Mailing Address - Country:US
Mailing Address - Phone:352-378-2525
Mailing Address - Fax:352-377-9772
Practice Address - Street 1:2121 NW 40TH TER
Practice Address - Street 2:SUITE C
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-5813
Practice Address - Country:US
Practice Address - Phone:352-378-2525
Practice Address - Fax:352-377-9772
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDN131871223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery