Provider Demographics
NPI:1700048204
Name:TAYLOR FAMILY DENTISTRY
Entity Type:Organization
Organization Name:TAYLOR FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-658-0859
Mailing Address - Street 1:3271 N MILWAUKEE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4427
Mailing Address - Country:US
Mailing Address - Phone:208-658-0859
Mailing Address - Fax:208-658-0893
Practice Address - Street 1:3271 N MILWAUKEE ST STE 3
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4427
Practice Address - Country:US
Practice Address - Phone:208-658-0859
Practice Address - Fax:208-658-0893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID36091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806330700Medicaid