Provider Demographics
NPI:1205933447
Name:TAYLOR, RAYMOND ALFRED JR (DDS)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:ALFRED
Last Name:TAYLOR
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:101 WOODBINE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601
Mailing Address - Country:US
Mailing Address - Phone:903-757-2824
Mailing Address - Fax:903-757-2826
Practice Address - Street 1:101 WOODBINE
Practice Address - Street 2:SUITE C
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601
Practice Address - Country:US
Practice Address - Phone:903-757-2824
Practice Address - Fax:903-757-2826
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1215111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice