Provider Demographics
NPI:1366584666
Name:TAYLOR, DONALD N JR (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:N
Last Name:TAYLOR
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-2858
Mailing Address - Country:US
Mailing Address - Phone:308-762-6131
Mailing Address - Fax:
Practice Address - Street 1:916 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-2858
Practice Address - Country:US
Practice Address - Phone:308-762-6131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4471122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE4471OtherLICENSE NUMBER
NE47063861500Medicaid