Provider Demographics
NPI:1891795605
Name:TAYLOR, KEITH HARRISON (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:HARRISON
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:544 ROLAND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-4302
Mailing Address - Country:US
Mailing Address - Phone:731-426-1834
Mailing Address - Fax:731-426-1836
Practice Address - Street 1:544 ROLAND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-4302
Practice Address - Country:US
Practice Address - Phone:731-426-1834
Practice Address - Fax:731-426-1836
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN77601223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery