Provider Demographics
NPI:1417673617
Name:MARTIN-TAYLOR DENTISTRY
Entity Type:Organization
Organization Name:MARTIN-TAYLOR DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HOWELL
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-747-9024
Mailing Address - Street 1:7350 E SPEEDWAY BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1366
Mailing Address - Country:US
Mailing Address - Phone:520-747-9024
Mailing Address - Fax:520-747-0148
Practice Address - Street 1:7350 E SPEEDWAY BLVD STE 201
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1366
Practice Address - Country:US
Practice Address - Phone:520-600-6925
Practice Address - Fax:520-747-0148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-18
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1396467791Medicaid
AZ1245302397Medicaid
AZ1023271335Medicaid