Provider Demographics
NPI:1417185828
Name:TAYLOR, JACOB M (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:M
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 1:525 HENRY CHAPPLE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-1865
Mailing Address - Country:US
Mailing Address - Phone:406-652-1600
Mailing Address - Fax:406-652-1205
Practice Address - Street 1:525 HENRY CHAPPLE ST STE 5
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106-1865
Practice Address - Country:US
Practice Address - Phone:406-652-1600
Practice Address - Fax:406-652-1205
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT23611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice