Individual
KELLI RENE FOWLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
2250 NE PROFESSIONAL CT, BEND, OR 97701-6063
(541) 388-1434
(541) 388-1293
Mailing address
2250 NE PROFESSIONAL CT, BEND, OR 97701-6063
(541) 388-1434
(541) 388-1293
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
8296732-9922
UT
122300000X
Dentist
Primary
D9948
OR
1223G0001X
General Practice Dentistry
LL-224-10
NV
Other
Enumeration date
08/27/2010
Last updated
01/10/2014
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