Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 43835 | AZ |
NPI | 1083011316 |
---|---|
Provider Name | Tayler Faircloth |
First Address | Scottsdale, AZ 85251 |
Second Address | Scottsdale, AZ 85251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2014 |
Last Update Date | 02/12/2014 |