Provider Demographics
NPI:1679894091
Name:TAYLOR, STEPHEN MARC (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MARC
Last Name:TAYLOR
Suffix:
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 1:5601 NW 72ND ST STE 142
Mailing Address - Street 2:
Mailing Address - City:WARR ACRES
Mailing Address - State:OK
Mailing Address - Zip Code:73132-5924
Mailing Address - Country:US
Mailing Address - Phone:405-722-4400
Mailing Address - Fax:405-473-7734
Practice Address - Street 1:5601 NW 72ND ST STE 142
Practice Address - Street 2:
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73132-5924
Practice Address - Country:US
Practice Address - Phone:405-722-4400
Practice Address - Fax:405-473-7734
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK62131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice