Provider Demographics
NPI:1902007511
Name:TAYLOR, JAY KIRKLAND (DDS)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:KIRKLAND
Last Name:TAYLOR
Suffix:
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 1:2910 UNIVERSITY DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6032
Mailing Address - Country:US
Mailing Address - Phone:701-235-1113
Mailing Address - Fax:701-280-2614
Practice Address - Street 1:2910 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6032
Practice Address - Country:US
Practice Address - Phone:701-235-1113
Practice Address - Fax:701-280-2614
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND18611223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics