Organization
TAYLOR C. FOWLES, DMD, LLC
Active
Other names
East Bend Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALECIA J JOLLIFFE (PRACTICE MANAGER)
(541) 388-1434
Entity
Organization
Contact information
Practice address
2250 NE PROFESSIONAL CT, BEND, OR 97701
(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
1223G0001X
General Practice Dentistry
Primary
—
—
124Q00000X
Dental Hygienist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D10810
OREGON DENTAL LICENSE
OR
01
—
D9910
OREGON DENTAL LICENSE
OR
01
—
D9948
OREGON DENTAL LICENSE
OR
Enumeration date
03/22/2012
Last updated
06/25/2018
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