Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 021-001693 | IL |
NPI | 1114935590 |
---|---|
Provider Name | Dr. D. Lance Taylor |
First Address | Springfield, IL 62704-4194 |
Second Address | Springfield, IL 62704-4194 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 16/03/2010 |