Mack Adam Taylor, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2014020286 Issued in MO

Practice address

913 West Business Highway 60
Suite C
Dexter, MO 63841-2704

Phone

(573) 624-7456

NPI assigned

Jul 31, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Southeast Missouri Health Network

  • Federally Qualified Health Center (FQHC)
  • Sikeston, MO
  • NPI 1619513215

  Other, W-2 Managing Employee

  CMS ownership
• Southeast Missouri Health Network

  • Federally Qualified Health Center (FQHC)
  • New Madrid, MO
  • NPI 1790531119

  Corporate Officer

  CMS ownership

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406764800000",
    "number": "1942618194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "913 WEST BUSINESS HIGHWAY 60",
            "address_2": "SUITE C",
            "city": "DEXTER",
            "state": "MO",
            "postal_code": "638412704",
            "telephone_number": "573-624-7456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "913 WEST BUSINESS HIGHWAY 60",
            "address_2": "SUITE C",
            "city": "DEXTER",
            "state": "MO",
            "postal_code": "638412704",
            "telephone_number": "573-624-7456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "MACK",
        "middle_name": "ADAM",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-31",
        "last_updated": "2014-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2014020286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Dexter, MO
• Providers in Dexter, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.