Provider Demographics
NPI:1326400789
Name:TAYLOR, COREY ALAN (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:ALAN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 SPRINGBANK LN STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3373
Mailing Address - Country:US
Mailing Address - Phone:704-541-3603
Mailing Address - Fax:
Practice Address - Street 1:3111 SPRINGBANK LN STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3373
Practice Address - Country:US
Practice Address - Phone:704-541-3603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC127571223S0112X
KY97851223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery