Provider Demographics
NPI:1255909750
Name:HAMMOCK, TAYLOR RICHARD (DMD)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:RICHARD
Last Name:HAMMOCK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17945 SW 97TH AVE APT 140
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5425
Mailing Address - Country:US
Mailing Address - Phone:843-902-8518
Mailing Address - Fax:
Practice Address - Street 1:255 SE 14TH ST STE 1A
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1852
Practice Address - Country:US
Practice Address - Phone:954-523-6525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-12
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL258281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice