Provider Demographics
NPI:1437193075
Name:TAYLOR, SHANE TRENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:TRENT
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 E FORT PIERCE DR N UNIT 8
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8855
Mailing Address - Country:US
Mailing Address - Phone:435-275-5000
Mailing Address - Fax:888-353-4948
Practice Address - Street 1:3016 W CHARLESTON BLVD STE 145
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1964
Practice Address - Country:US
Practice Address - Phone:702-380-1212
Practice Address - Fax:888-353-4948
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9734486699221223G0001X
NV49651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice