Provider Demographics
NPI:1245861665
Name:TAYLOR HOUSTON SHANK, DDS, A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:TAYLOR HOUSTON SHANK, DDS, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:HOUSTON
Authorized Official - Last Name:SHANK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-235-8902
Mailing Address - Street 1:130 BEAUCHAMP LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-9261
Mailing Address - Country:US
Mailing Address - Phone:337-852-2803
Mailing Address - Fax:
Practice Address - Street 1:313 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-8061
Practice Address - Country:US
Practice Address - Phone:337-235-8902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental