Provider Demographics
NPI:1326619594
Name:MCGREEVEY, TAYLOR EDWARD (DMD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:EDWARD
Last Name:MCGREEVEY
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 1:1201 SW HIGGINS AVE APT L
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-3603
Mailing Address - Country:US
Mailing Address - Phone:406-546-1932
Mailing Address - Fax:
Practice Address - Street 1:5577 US HIGHWAY 93 N
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MT
Practice Address - Zip Code:59833-6845
Practice Address - Country:US
Practice Address - Phone:406-273-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-21457122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist