Provider Demographics
NPI:1780109348
Name:NATHANIEL M. TAYLOR, DMD, LLC.
Entity type:Organization
Organization Name:NATHANIEL M. TAYLOR, DMD, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JANIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-457-1221
Mailing Address - Street 1:6391 ROYALTON RD STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-4922
Mailing Address - Country:US
Mailing Address - Phone:440-457-1221
Mailing Address - Fax:440-457-1223
Practice Address - Street 1:6391 ROYALTON RD STE A
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-4922
Practice Address - Country:US
Practice Address - Phone:440-457-1221
Practice Address - Fax:440-457-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH22807305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1598920589OtherINDIVIDUAL NATIONAL PROVIDER IDENTIFIER