Active NPI
Kelli Rene Fowles, DMD
- Dentist
- Bend, OR
National Provider Identifier
1427364439
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D9948
- Practice address
- 2250 NE Professional CT
Bend, OR 97701-6063 - Phone
- (541) 388-1434
- Fax
- (541) 388-1293
- NPI assigned
- Aug 27, 2010
- Last updated
- Jan 10, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8296732-9922 | UT | |
| Dentist | 122300000X | D9948 | OR | Primary |
| General Practice Dentistry | 1223G0001X | LL-224-10 | NV |
Addresses
Primary practice location
2250 NE Professional CT
Bend, OR 97701-6063
Mailing address
2250 NE Professional CT
Bend, OR 97701-6063
Phone (541) 388-1434
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160120000695 | OR | Order and Referring Only - Dentist | 2163725433 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8296732-9922 | UT | MD | Dentist |
| LL-224-10 | NV | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Taylor C. Fowles, DMD, LLC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389312000000",
"number": "1427364439",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2250 NE PROFESSIONAL CT",
"city": "BEND",
"state": "OR",
"postal_code": "977016063",
"telephone_number": "541-388-1434",
"fax_number": "541-388-1293"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2250 NE PROFESSIONAL CT",
"city": "BEND",
"state": "OR",
"postal_code": "977016063",
"telephone_number": "541-388-1434",
"fax_number": "541-388-1293"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOWLES",
"first_name": "KELLI",
"middle_name": "RENE",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-08-27",
"last_updated": "2014-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "UT",
"license": "8296732-9922",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D9948",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NV",
"license": "LL-224-10",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.