Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 00000000000000000000 | PA |
Y | 1223P0221X | Pediatric Dentist | 25175 | TX |
NPI | 1104086735 |
---|---|
Provider Name | Dr. Craig Lynn Taylor |
First Address | Cedar Park, TX 78613-3191 |
Second Address | Austin, TX 78758-7861 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2008 |
Last Update Date | 25/11/2020 |