Provider Demographics
NPI:1700298262
Name:TAYLOR, CARLTON (DMD)
Entity Type:Individual
Prefix:
First Name:CARLTON
Middle Name:
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 1:3085 W INA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2382
Mailing Address - Country:US
Mailing Address - Phone:520-219-1900
Mailing Address - Fax:520-696-0702
Practice Address - Street 1:3085 W INA RD STE 101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741
Practice Address - Country:US
Practice Address - Phone:520-219-1900
Practice Address - Fax:520-696-0702
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZD98361223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program