Provider Demographics
NPI:1780899963
Name:TAYLOR, JAMES CARL JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CARL
Last Name:TAYLOR
Suffix:JR
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 1:310 W OAKLAWN RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78064-4033
Mailing Address - Country:US
Mailing Address - Phone:830-569-8940
Mailing Address - Fax:830-569-8527
Practice Address - Street 1:302 N BUTLER ST
Practice Address - Street 2:
Practice Address - City:KARNES CITY
Practice Address - State:TX
Practice Address - Zip Code:78118-2801
Practice Address - Country:US
Practice Address - Phone:830-780-3600
Practice Address - Fax:830-780-3730
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126775907Medicaid
TXTXB136054Medicare PIN
TX126775907Medicaid