Provider Demographics
NPI:1396894440
Name:TAYLOR, JEFFREY L (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-1915
Mailing Address - Country:US
Mailing Address - Phone:410-228-2980
Mailing Address - Fax:410-228-8283
Practice Address - Street 1:110 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1915
Practice Address - Country:US
Practice Address - Phone:410-228-2980
Practice Address - Fax:410-228-8283
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD69341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice