Provider Demographics
NPI:1275785693
Name:BRUCE W. TAYLOR, D.D.S.
Entity Type:Organization
Organization Name:BRUCE W. TAYLOR, D.D.S.
Other - Org Name:TAYLOR FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-972-6985
Mailing Address - Street 1:2000 FIELDERS RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-1937
Mailing Address - Country:US
Mailing Address - Phone:870-972-6985
Mailing Address - Fax:870-972-5536
Practice Address - Street 1:2000 FIELDERS RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-1937
Practice Address - Country:US
Practice Address - Phone:870-972-6985
Practice Address - Fax:870-972-5536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR27321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty