Basic Information
| Provider Information | |||||||||
| NPI: | 1780899963 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | CARL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 W OAKLAWN RD | ||||||||
| Address2: | |||||||||
| City: | PLEASANTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780644033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8305698940 | ||||||||
| FaxNumber: | 8305698527 | ||||||||
| Practice Location | |||||||||
| Address1: | 302 N BUTLER ST | ||||||||
| Address2: | |||||||||
| City: | KARNES CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781182801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8307803600 | ||||||||
| FaxNumber: | 8307803730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2007 | ||||||||
| LastUpdateDate: | 02/17/2014 | ||||||||
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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 | 12158 | TX | Y | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 126775907 | 05 | TX | MEDICAID |