Provider Demographics
NPI:1508477530
Name:TAYLOR, BRANDON MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:MICHAEL
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 1:2047 E LESTER AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3963
Mailing Address - Country:US
Mailing Address - Phone:559-907-4773
Mailing Address - Fax:
Practice Address - Street 1:KAMIYAMA
Practice Address - Street 2:
Practice Address - City:GINOWAN
Practice Address - State:OKINAWA
Practice Address - Zip Code:9012207
Practice Address - Country:JP
Practice Address - Phone:098-911-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD112931223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program