Provider Demographics
NPI:1245411644
Name:JOHN W. TAYLOR, DDS, PLLC
Entity Type:Organization
Organization Name:JOHN W. TAYLOR, DDS, PLLC
Other - Org Name:KIDS GRINS PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-830-5466
Mailing Address - Street 1:4540 E BASELINE RD.
Mailing Address - Street 2:STE. 102
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206
Mailing Address - Country:US
Mailing Address - Phone:480-830-5466
Mailing Address - Fax:480-830-5577
Practice Address - Street 1:4540 E BASELINE RD.
Practice Address - Street 2:STE. 102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206
Practice Address - Country:US
Practice Address - Phone:480-830-5466
Practice Address - Fax:480-830-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223P0221X
AZ83861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ689851Medicaid