Provider Demographics
NPI:1396908166
Name:TAYLOR, MARYSIA LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARYSIA
Middle Name:LYNN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2989 W ROCK QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-4118
Mailing Address - Country:US
Mailing Address - Phone:770-932-4539
Mailing Address - Fax:
Practice Address - Street 1:2989 W ROCK QUARRY RD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4118
Practice Address - Country:US
Practice Address - Phone:770-932-4539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011454122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist