Provider Demographics
NPI:1750467957
Name:TAYLOR, AMY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:42D MEDICAL GROUP
Mailing Address - Street 2:300 S TWINNING ST. BLDG. 760
Mailing Address - City:MAXWELL AFB
Mailing Address - State:AL
Mailing Address - Zip Code:36112
Mailing Address - Country:US
Mailing Address - Phone:334-953-3368
Mailing Address - Fax:334-953-8607
Practice Address - Street 1:42D MEDICAL GROUP
Practice Address - Street 2:300 S. TWINNING ST. BLDG 760
Practice Address - City:MAXWELL AFB
Practice Address - State:AL
Practice Address - Zip Code:36112
Practice Address - Country:US
Practice Address - Phone:513-460-3877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30021784122300000X
NMDD4884122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2417763Medicaid