Provider Demographics
NPI:1982157806
Name:H DAVID TAYLOR
Entity Type:Organization
Organization Name:H DAVID TAYLOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:UMPHLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:307-527-7571
Mailing Address - Street 1:1114 RUMSEY AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3606
Mailing Address - Country:US
Mailing Address - Phone:307-527-7571
Mailing Address - Fax:
Practice Address - Street 1:1114 RUMSEY AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3606
Practice Address - Country:US
Practice Address - Phone:307-527-7571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY884122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY122300000XMedicaid