Provider Demographics
NPI:1265533608
Name:TAYLOR, STEPHEN FREDERICK (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:FREDERICK
Last Name:TAYLOR
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:PO BOX 1168
Mailing Address - Street 2:33454 HAVLIK RD
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056
Mailing Address - Country:US
Mailing Address - Phone:503-543-3136
Mailing Address - Fax:503-543-5243
Practice Address - Street 1:33454 HAVLIK ROAD
Practice Address - Street 2:
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056
Practice Address - Country:US
Practice Address - Phone:503-543-3136
Practice Address - Fax:503-543-5243
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5804122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist