Provider Demographics
NPI:1851394647
Name:TAYLOR, RAY MALCOLM JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:MALCOLM
Last Name:TAYLOR
Suffix:JR
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 1:3028 N WOOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-9469
Mailing Address - Country:US
Mailing Address - Phone:330-364-4838
Mailing Address - Fax:330-364-5845
Practice Address - Street 1:3028 N WOOSTER AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-9469
Practice Address - Country:US
Practice Address - Phone:330-364-4838
Practice Address - Fax:330-364-5845
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19771122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist