Basic Information
| Provider Information | |||||||||
| NPI: | 1730297920 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 WALLER ST | ||||||||
| Address2: | ATTN: FINANCE, 5TH FLOOR | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787025240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129789000 | ||||||||
| FaxNumber: | 5129789001 | ||||||||
| Practice Location | |||||||||
| Address1: | 1210 W BRAKER LANE | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787583308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129789880 | ||||||||
| FaxNumber: | 5122792556 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 01/30/2012 | ||||||||
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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 | 16543 | TX | Y | Dental Providers | Dentist | General Practice |
No ID Information.