Provider Demographics
NPI:1417012774
Name:MARVIN S. TAYLOR DDS PC
Entity Type:Organization
Organization Name:MARVIN S. TAYLOR DDS PC
Other - Org Name:DR TAYLORS FAMILY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-681-8100
Mailing Address - Street 1:1770 GOLF RIDGE DR S
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1730
Mailing Address - Country:US
Mailing Address - Phone:248-681-8100
Mailing Address - Fax:248-681-6318
Practice Address - Street 1:1101 W HURON ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3736
Practice Address - Country:US
Practice Address - Phone:248-681-8100
Practice Address - Fax:248-681-6318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI095681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty