Basic Information
| Provider Information | |||||||||
| NPI: | 1285678151 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | CLINTON | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 RANDOLPH ST | ||||||||
| Address2: | PO BOX 660 | ||||||||
| City: | DENTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216291243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104794306 | ||||||||
| FaxNumber: | 4104791714 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 DUTCHMANS LN | ||||||||
| Address2: | |||||||||
| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216013312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108224310 | ||||||||
| FaxNumber: | 4108223196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 08/03/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 3956 | MD | Y | Dental Providers | Dentist | General Practice |
No ID Information.