Provider Demographics
NPI:1225362411
Name:DR D G TAYLOR PC
Entity Type:Organization
Organization Name:DR D G TAYLOR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:P
Authorized Official - Last Name:TROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-685-5555
Mailing Address - Street 1:634 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIDGE SPRING
Mailing Address - State:SC
Mailing Address - Zip Code:29129-9139
Mailing Address - Country:US
Mailing Address - Phone:803-685-5555
Mailing Address - Fax:803-685-5519
Practice Address - Street 1:634 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RIDGE SPRING
Practice Address - State:SC
Practice Address - Zip Code:29129-9139
Practice Address - Country:US
Practice Address - Phone:803-685-5555
Practice Address - Fax:803-685-5519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZZ2602Medicaid