Provider Demographics
NPI:1922261916
Name:TAYLOR, GODRICK ALLISTER
Entity Type:Individual
Prefix:DR
First Name:GODRICK
Middle Name:ALLISTER
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 1:1031 E 102ND ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4419
Mailing Address - Country:US
Mailing Address - Phone:347-204-3362
Mailing Address - Fax:
Practice Address - Street 1:8215 ROOSEVELT AVE FL 2
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7034
Practice Address - Country:US
Practice Address - Phone:718-205-7709
Practice Address - Fax:718-205-7718
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0520711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice