Provider Demographics
NPI:1558422345
Name:TAYLOR, ANDREW ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ALLEN
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 1:108 COOK ST
Mailing Address - Street 2:
Mailing Address - City:CLARKS GREEN
Mailing Address - State:PA
Mailing Address - Zip Code:18411
Mailing Address - Country:US
Mailing Address - Phone:570-586-9717
Mailing Address - Fax:570-586-5446
Practice Address - Street 1:327 N WASHINGTON AVE
Practice Address - Street 2:SUITE 709 SCRANTON PROFESSIONAL ARTS
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1549
Practice Address - Country:US
Practice Address - Phone:570-344-4699
Practice Address - Fax:570-346-8721
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026823L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015015100002Medicaid