Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 011360 | GA |
NPI | 1013021120 |
---|---|
Provider Name | Dr. Richard Alan Taylor |
First Address | Rincon, GA 31326 |
Second Address | Rincon, GA 31326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 08/07/2007 |