Provider Demographics
NPI:1730297920
Name:TAYLOR, PHILIP O I
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:O
Last Name:TAYLOR
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WALLER ST
Mailing Address - Street 2:ATTN: FINANCE, 5TH FLOOR
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-5240
Mailing Address - Country:US
Mailing Address - Phone:512-978-9000
Mailing Address - Fax:512-978-9001
Practice Address - Street 1:1210 W BRAKER LANE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-3308
Practice Address - Country:US
Practice Address - Phone:512-978-9880
Practice Address - Fax:512-279-2556
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX165431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice