Provider Demographics
NPI:1316028244
Name:TAYLOR, PENNY LEE (DMD,MS,PC)
Entity Type:Individual
Prefix:DR
First Name:PENNY
Middle Name:LEE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DMD,MS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 DANVILLE RD SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-4213
Mailing Address - Country:US
Mailing Address - Phone:256-351-1118
Mailing Address - Fax:256-351-1142
Practice Address - Street 1:2514 DANVILLE RD SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-4213
Practice Address - Country:US
Practice Address - Phone:256-351-1118
Practice Address - Fax:256-351-1142
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL45481223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics