Provider Demographics
NPI:1629007042
Name:TAYLOR, TREVOR CLAY (DDS)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:CLAY
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:TREVOR
Other - Middle Name:CLAY
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:53 SITZ DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-2156
Mailing Address - Country:US
Mailing Address - Phone:931-723-6464
Mailing Address - Fax:931-723-6404
Practice Address - Street 1:53 SITZ DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2156
Practice Address - Country:US
Practice Address - Phone:931-723-6464
Practice Address - Fax:931-723-6404
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN85071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice