Provider Demographics
NPI:1225359292
Name:TAYLOR, JARED LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:LYNN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JARED
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JARED L TAYLOR
Mailing Address - Street 1:2620 JACKSON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3478
Mailing Address - Country:US
Mailing Address - Phone:605-348-1712
Mailing Address - Fax:
Practice Address - Street 1:2620 JACKSON BLVD STE B
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3478
Practice Address - Country:US
Practice Address - Phone:605-348-1712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ79861223G0001X
SDD10021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice