Provider Demographics
NPI:1588683221
Name:TAYLOR, JEFFREY JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JOHN
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 1:313 MAIN ST W
Mailing Address - Street 2:PO BOX 307
Mailing Address - City:MAPLETON
Mailing Address - State:MN
Mailing Address - Zip Code:56065-2062
Mailing Address - Country:US
Mailing Address - Phone:507-524-3830
Mailing Address - Fax:507-524-4705
Practice Address - Street 1:313 MAIN ST W
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:MN
Practice Address - Zip Code:56065-2062
Practice Address - Country:US
Practice Address - Phone:507-524-3830
Practice Address - Fax:507-524-4705
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN88771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN832302OtherUNITED CONCORDIA
MN41654 TAOtherBLUE CROSS BLUE SHIELD