Provider Demographics
NPI:1770546327
Name:TAYLOR, BRIAN (DMD)
Entity type:Individual
Prefix:
First Name:BRIAN
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 1:2300 FREEPORT RD
Mailing Address - Street 2:FELDARELLI SQUARE, SUITE 1B
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-4669
Mailing Address - Country:US
Mailing Address - Phone:724-212-3167
Mailing Address - Fax:724-212-3169
Practice Address - Street 1:2300 FREEPORT RD
Practice Address - Street 2:FELDARELLI SQUARE, SUITE 1B
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-4669
Practice Address - Country:US
Practice Address - Phone:724-212-3167
Practice Address - Fax:724-212-3169
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0298471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016077330010Medicaid
PA0016077330015Medicaid
PA0016077330006Medicaid
PA0016077330007Medicaid
PA0016077330017Medicaid
PA0016077330003Medicaid
PA0016077330013Medicaid
PA0016077330001Medicaid
PA0016077330016Medicaid
PA0016077330014Medicaid
PA0016077330018Medicaid
PA0016077330009Medicaid
PA0016077330011Medicaid