Provider Demographics
NPI:1780734780
Name:TAYLOR, BRYAN EDWARD (DDS)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:EDWARD
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 1:8304 OLD MCGREGOR RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3600
Mailing Address - Country:US
Mailing Address - Phone:254-776-4818
Mailing Address - Fax:254-776-7803
Practice Address - Street 1:8304 OLD MCGREGOR RD
Practice Address - Street 2:SUITE A
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3600
Practice Address - Country:US
Practice Address - Phone:254-776-4818
Practice Address - Fax:254-776-7803
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX156721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics