Provider Demographics
NPI:1851582407
Name:TAYLOR, ALBERTO
Entity Type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:
Last Name:TAYLOR
Suffix:
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 1:791 BAYSIDE ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521
Mailing Address - Country:US
Mailing Address - Phone:707-822-4826
Mailing Address - Fax:707-822-7467
Practice Address - Street 1:791 BAYSIDE ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521
Practice Address - Country:US
Practice Address - Phone:707-822-4826
Practice Address - Fax:707-822-7467
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA394501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice