Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 7026989-9921 | UT |
NPI | 1013135961 |
---|---|
Provider Name | Robert Ryan Taylor |
First Address | Sandy, UT 84092 |
Second Address | Orem, UT 84057-2542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 31/07/2008 |