Jonathan David Taylor, DMD
Individual provider Active NPI Dentist · McConnell Afb, KS
NPI 1417424367 · NPPES record last updated Aug 24, 2021
Key facts
- NPI
- 1417424367
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- Practice address
- 22D Medical Group
57950 Leavenworth St
McConnell Afb, KS 67221-3506 - Phone
- (316) 759-5181
- NPI assigned
- Oct 30, 2018
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0 | OH | Yes |
Addresses
Primary practice location
22D Medical Group
57950 Leavenworth St
McConnell Afb, KS 67221-3506
Mailing address
22D Medical Group
57950 Leavenworth St
McConnell Afb, KS 67221-3506
Phone (316) 759-4492
Other providers in McConnell Afb, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 24, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.