Provider Demographics
NPI:1679662449
Name:J M TAYLOR DDS INC
Entity Type:Organization
Organization Name:J M TAYLOR DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-843-2996
Mailing Address - Street 1:409 W TYLER ST
Mailing Address - Street 2:
Mailing Address - City:GILMER
Mailing Address - State:TX
Mailing Address - Zip Code:75644
Mailing Address - Country:US
Mailing Address - Phone:903-843-2996
Mailing Address - Fax:903-843-3616
Practice Address - Street 1:409 W TYLER ST
Practice Address - Street 2:
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75644
Practice Address - Country:US
Practice Address - Phone:903-843-2996
Practice Address - Fax:903-843-3616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
794829OtherUNITED CONCORDIA