Provider Demographics
NPI:1235527565
Name:KENNETH A. TAYLOR D.D.S., P.S.
Entity Type:Organization
Organization Name:KENNETH A. TAYLOR D.D.S., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST & CORP. PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-650-1458
Mailing Address - Street 1:610 DUPONT ST
Mailing Address - Street 2:SUITE 132
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4054
Mailing Address - Country:US
Mailing Address - Phone:360-650-1458
Mailing Address - Fax:360-650-1469
Practice Address - Street 1:610 DUPONT ST
Practice Address - Street 2:SUITE 132
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4054
Practice Address - Country:US
Practice Address - Phone:360-650-1458
Practice Address - Fax:360-650-1469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00008941261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental