Provider Demographics
NPI:1598879975
Name:TAYLOR, BOBBY NEIL I (DDS)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:NEIL
Last Name:TAYLOR
Suffix:I
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 1:2900 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-1808
Mailing Address - Country:US
Mailing Address - Phone:432-367-8030
Mailing Address - Fax:
Practice Address - Street 1:4208 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-7152
Practice Address - Country:US
Practice Address - Phone:432-367-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice