Provider Demographics
NPI:1144536483
Name:TAYLOR, MARK ROSS (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ROSS
Last Name:TAYLOR
Suffix:
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 1:2560 E 3300 S # 200
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-2749
Mailing Address - Country:US
Mailing Address - Phone:801-486-3888
Mailing Address - Fax:801-486-4170
Practice Address - Street 1:2560 E 3300 S # 200
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-2749
Practice Address - Country:US
Practice Address - Phone:801-486-3888
Practice Address - Fax:801-486-4170
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT142210-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice