Provider Demographics
NPI:1447394721
Name:TAYLOR, MICHAEL KEMP (DDS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KEMP
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:PO BOX 1038
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-1038
Mailing Address - Country:US
Mailing Address - Phone:828-264-3333
Mailing Address - Fax:828-264-6340
Practice Address - Street 1:870 STATE FARM RD
Practice Address - Street 2:SUITE 103A
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4861
Practice Address - Country:US
Practice Address - Phone:828-264-3333
Practice Address - Fax:828-264-6340
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1046911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC40899Medicaid
NC8998295Medicaid
NC811744OtherUNITED CONCORIDA#
NC98295OtherBCBS #