Provider Demographics
NPI:1508909169
Name:TAYLOR, KENNETH WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:WAYNE
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 1:3819 TOWNE CROSSING BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-2799
Mailing Address - Country:US
Mailing Address - Phone:972-270-1515
Mailing Address - Fax:972-613-4776
Practice Address - Street 1:3819 TOWNE CROSSING BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2799
Practice Address - Country:US
Practice Address - Phone:972-270-1515
Practice Address - Fax:972-613-4776
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX151001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice