# GLENN N TAYLOR JR DMD MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821127549
- **Authorized official:** DR. GLENN N TAYLOR JR. DMD MD (ORAL SURGEON)
- **Authorized official phone:** (904) 261-6068

## Contact information

- **Practice address:** 1947 CITRONA DRIVE, FERNANDINA BEACH, FL 32034
- **Practice address phone:** (904) 261-6068
- **Practice address fax:** (904) 261-9797
- **Mailing address:** 4202 NW 155TH TERRACE, NEWBERRY, FL 32669
- **Mailing address phone:** (352) 332-2876
- **Mailing address fax:** (352) 332-1113

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DN13187 | FL | Yes |

## Other

- **Enumeration date:** 03/06/2007
- **Last updated:** 08/22/2020