Provider Demographics
NPI:1225343791
Name:TAYLOR, RANDALL WILLIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:WILLIAM
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15940 ARENA DR
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-4202
Mailing Address - Country:US
Mailing Address - Phone:619-920-0321
Mailing Address - Fax:
Practice Address - Street 1:15940 ARENA DR
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-4202
Practice Address - Country:US
Practice Address - Phone:619-920-0321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59579122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist