Provider Demographics
NPI:1174064133
Name:JEFFREY L TAYLOR DDS & ASSOCIATES 1
Entity type:Organization
Organization Name:JEFFREY L TAYLOR DDS & ASSOCIATES 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MANTONI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-587-6696
Mailing Address - Street 1:8757 GEORGIA AVE
Mailing Address - Street 2:SUITE 530
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3737
Mailing Address - Country:US
Mailing Address - Phone:301-587-6696
Mailing Address - Fax:301-608-9648
Practice Address - Street 1:8757 GEORGIA AVE
Practice Address - Street 2:SUITE 530
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3737
Practice Address - Country:US
Practice Address - Phone:301-587-6696
Practice Address - Fax:301-608-9648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD67021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC045072700Medicaid