Provider Demographics
NPI:1982644530
Name:TAYLOR JR., ROBERT M (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:TAYLOR JR.
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 1:279 N THIRD ST
Mailing Address - Street 2:P.O. BOX 139
Mailing Address - City:ROGERS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49779-1610
Mailing Address - Country:US
Mailing Address - Phone:989-734-4973
Mailing Address - Fax:989-734-7242
Practice Address - Street 1:279 N THIRD ST
Practice Address - Street 2:
Practice Address - City:ROGERS CITY
Practice Address - State:MI
Practice Address - Zip Code:49779-1610
Practice Address - Country:US
Practice Address - Phone:989-734-4973
Practice Address - Fax:989-734-7242
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI113551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice