Provider Demographics
NPI:1013077833
Name:TAYLOR, THAD IV (DDS)
Entity Type:Individual
Prefix:DR
First Name:THAD
Middle Name:
Last Name:TAYLOR
Suffix:IV
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:2630 S CARRIER PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-5069
Mailing Address - Country:US
Mailing Address - Phone:214-762-1474
Mailing Address - Fax:972-572-3900
Practice Address - Street 1:2630 S CARRIER PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-5069
Practice Address - Country:US
Practice Address - Phone:214-762-1474
Practice Address - Fax:972-572-3900
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX189481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery