Provider Demographics
NPI:1851358956
Name:TAYLOR, GREGORY DAVID (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DAVID
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 MAIN ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7625
Mailing Address - Country:US
Mailing Address - Phone:817-424-1166
Mailing Address - Fax:817-416-0700
Practice Address - Street 1:1422 MAIN ST
Practice Address - Street 2:SUITE 240
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7625
Practice Address - Country:US
Practice Address - Phone:817-424-1166
Practice Address - Fax:817-416-0700
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208151223S0112X
TXL5584204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH87528Medicare UPIN