Provider Demographics
NPI:1508084997
Name:TAYLOR, RANDALL KEITH (DMD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:KEITH
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 1:700 WHITNELL ST
Mailing Address - Street 2:PO BOX 1538
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2966
Mailing Address - Country:US
Mailing Address - Phone:270-753-9201
Mailing Address - Fax:270-753-9271
Practice Address - Street 1:700 WHITNELL ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2966
Practice Address - Country:US
Practice Address - Phone:270-753-9201
Practice Address - Fax:270-753-9271
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7119122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist