Provider Demographics
NPI:1376388850
Name:ANNAS, TAYLOR (DMD)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:
Last Name:ANNAS
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 1:2065 CLEARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-1015
Mailing Address - Country:US
Mailing Address - Phone:586-850-8438
Mailing Address - Fax:
Practice Address - Street 1:4201 E BELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2211
Practice Address - Country:US
Practice Address - Phone:480-605-3666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0122471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice