Provider Demographics
NPI:1831882059
Name:ANDERSON, TAYLOR REID (DMD)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:REID
Last Name:ANDERSON
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 1:1125 W KAGY BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-5879
Mailing Address - Country:US
Mailing Address - Phone:406-283-4888
Mailing Address - Fax:
Practice Address - Street 1:1125 W KAGY BLVD STE 303
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5879
Practice Address - Country:US
Practice Address - Phone:406-283-4888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-26011122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist