Provider Demographics
NPI:1447561147
Name:TAYLOR, KEVIN (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
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 1:3212 S WILMINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-3538
Mailing Address - Country:US
Mailing Address - Phone:919-773-3002
Mailing Address - Fax:919-773-8824
Practice Address - Street 1:2211 EXECUTIVE ST
Practice Address - Street 2:SUITE E
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-3661
Practice Address - Country:US
Practice Address - Phone:704-395-6000
Practice Address - Fax:704-398-7373
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC90031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice