Provider Demographics
NPI:1861690398
Name:TAYLOR, NICHOLAS ALLEN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ALLEN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
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Mailing Address - Street 1:3566 TEAYS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9090
Mailing Address - Country:US
Mailing Address - Phone:304-562-7817
Mailing Address - Fax:304-562-7820
Practice Address - Street 1:3566 TEAYS VALLEY RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9090
Practice Address - Country:US
Practice Address - Phone:304-562-7817
Practice Address - Fax:304-562-7820
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV36861223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics