Provider Demographics
NPI:1942618194
Name:TAYLOR, MACK ADAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:MACK
Middle Name:ADAM
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 1:913 WEST BUSINESS HIGHWAY 60
Mailing Address - Street 2:SUITE C
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-2704
Mailing Address - Country:US
Mailing Address - Phone:573-624-7456
Mailing Address - Fax:
Practice Address - Street 1:913 WEST BUSINESS HIGHWAY 60
Practice Address - Street 2:SUITE C
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-2704
Practice Address - Country:US
Practice Address - Phone:573-624-7456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014020286122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist