Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 38758 | CA |
NPI | 1003047879 |
---|---|
Provider Name | Dr. Scott M Taylor |
First Address | Thousand Oaks, CA 91360 |
Second Address | Thousand Oaks, CA 91360-4261 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2009 |
Last Update Date | 28/07/2009 |