Provider Demographics
NPI:1750443925
Name:TAYLOR, JEFFERY B (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:B
Last Name:TAYLOR
Suffix:
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 1:30100 CROWN VALLEY PKWY STE 42
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2041
Mailing Address - Country:US
Mailing Address - Phone:949-495-6677
Mailing Address - Fax:949-249-1330
Practice Address - Street 1:30100 CROWN VALLEY PKWY STE 42
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2041
Practice Address - Country:US
Practice Address - Phone:949-495-6677
Practice Address - Fax:949-249-1330
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice