Individual ProviderTaylor DameworthDentistDental ProvidersPractice Address3445 Henderson Dr, Jacksonville, NC 28546-5233(910) 347-1283PECOS EnrollmentBased on the most recent information from CMS, provider Taylor Dameworth is legally eligible to order and refer claims for Part B, HHA and DME services only.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1184363905Provider TypeIndividualFull NameDameworth, TaylorCredentialDDSGenderMaleSole ProprietorYesEnumeration Date5/31/2022Last Updated6/5/2022Contact InformationPractice LocationPractice Address3445 Henderson Dr, Jacksonville, NC 28546-5233Phone(910) 347-1283FaxUnlisted FaxMailing LocationMailing Address3445 Henderson Dr, Jacksonville, NC 28546-5233PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1223G0001XPrimaryDescriptionDentistDental ProvidersLicense12717North Carolina