Provider Demographics
NPI:1548428899
Name:GARY N TAYLOR DDS, MS, PC
Entity Type:Organization
Organization Name:GARY N TAYLOR DDS, MS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-579-0488
Mailing Address - Street 1:475 W 55TH ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-3564
Mailing Address - Country:US
Mailing Address - Phone:708-579-0488
Mailing Address - Fax:
Practice Address - Street 1:475 W 55TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-3564
Practice Address - Country:US
Practice Address - Phone:708-579-0488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021-0009781223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty