Provider Demographics
NPI:1891457347
Name:TAYLOR DENTAL PENSACOLA
Entity Type:Organization
Organization Name:TAYLOR DENTAL PENSACOLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CODIE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:GARNER-LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:850-478-8005
Mailing Address - Street 1:6601 N DAVIS HWY STE 8
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6210
Mailing Address - Country:US
Mailing Address - Phone:850-478-8005
Mailing Address - Fax:850-478-6871
Practice Address - Street 1:6601 N DAVIS HWY STE 8
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6210
Practice Address - Country:US
Practice Address - Phone:850-478-8005
Practice Address - Fax:850-478-6871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1366858771OtherDENTAL
FL1508846395OtherDENTAL
FL1134503477OtherDENTAL