Provider Demographics
NPI:1386198562
Name:TAYLOR, JEREMIAH ERWIN (DMD)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:ERWIN
Last Name:TAYLOR
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 1:2 IRIS ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2705
Mailing Address - Country:US
Mailing Address - Phone:828-252-2791
Mailing Address - Fax:
Practice Address - Street 1:2 IRIS ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2705
Practice Address - Country:US
Practice Address - Phone:828-252-2791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12081122300000X
TX32128122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12081OtherNC DENTAL LICENSE