Provider Demographics
NPI:1265666168
Name:TAYLOR, JEFFREY WATSON (DMD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:WATSON
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 1:1745 HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:SOUTHSIDE
Mailing Address - State:AL
Mailing Address - Zip Code:35907-0169
Mailing Address - Country:US
Mailing Address - Phone:256-442-1463
Mailing Address - Fax:256-442-9821
Practice Address - Street 1:1745 HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:SOUTHSIDE
Practice Address - State:AL
Practice Address - Zip Code:35907-0169
Practice Address - Country:US
Practice Address - Phone:256-442-1463
Practice Address - Fax:256-442-9821
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL57051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice