Provider Demographics
NPI:1932282563
Name:JEFFERY Y. TAYLOR DMD, PA
Entity Type:Organization
Organization Name:JEFFERY Y. TAYLOR DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-896-4325
Mailing Address - Street 1:431 SECURITY SQ
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-1922
Mailing Address - Country:US
Mailing Address - Phone:228-896-4325
Mailing Address - Fax:228-896-5787
Practice Address - Street 1:431 SECURITY SQ
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-1922
Practice Address - Country:US
Practice Address - Phone:228-896-4325
Practice Address - Fax:228-896-5787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPER242931223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
696993OtherACTIVE DUTY MILITARY