Provider Demographics
NPI:1205453206
Name:PEDEGO, TAYLOR MICHAEL (DDS)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MICHAEL
Last Name:PEDEGO
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 1:4858 BENTON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2708
Mailing Address - Country:US
Mailing Address - Phone:978-886-7560
Mailing Address - Fax:
Practice Address - Street 1:3025 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-2001
Practice Address - Country:US
Practice Address - Phone:303-458-7051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA610852441223G0001X
CODEN.002049221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice