Provider Demographics
NPI:1275732497
Name:ROBERT M TAYLOR III DDS PLC
Entity Type:Organization
Organization Name:ROBERT M TAYLOR III DDS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MALCOLM
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-684-9110
Mailing Address - Street 1:1610 S EUCLID
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-3320
Mailing Address - Country:US
Mailing Address - Phone:989-684-9110
Mailing Address - Fax:989-684-2812
Practice Address - Street 1:1610 S EUCLID
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706
Practice Address - Country:US
Practice Address - Phone:989-684-9110
Practice Address - Fax:989-684-2812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010182691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty