Provider Demographics
NPI:1922181429
Name:TRAYLOR, MICHAEL D (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:TRAYLOR
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 1:13925 MEEKER BLVD. BLDG A,
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375
Mailing Address - Country:US
Mailing Address - Phone:623-544-9600
Mailing Address - Fax:623-544-9602
Practice Address - Street 1:13925 W MEEKER BLVD BLDG A
Practice Address - Street 2:SUITE 6
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4430
Practice Address - Country:US
Practice Address - Phone:623-544-9600
Practice Address - Fax:623-544-9602
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice