Individual
BRANDON L TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3271 N MILWAUKEE ST, SUITE 3, BOISE, ID 83704-4425
(208) 658-0859
(208) 658-0893
Mailing address
3271 N MILWAUKEE, SUITE 3, BOISE, ID 83704
(208) 658-0859
(208) 658-0893
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3609
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1428313
UNITED CONCORDIA PROV. #
ID
05
—
206330700
—
ID
Enumeration date
03/16/2006
Last updated
08/08/2023
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