Taylor C. Fowles, DMD, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

TAYLOR C. FOWLES, DMD, LLC

Doing business as

East Bend Dental

Practice address

2250 NE Professional CT
Bend, OR 97701

Phone

(541) 388-1434

Fax

(541) 388-1293

NPI assigned

Mar 22, 2012

Organization subpart

No

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

Authorized official

Name

Mrs. Alecia J Jolliffe

Title

Practice Manager

Phone

(541) 388-1434

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• East Bend Dental Doing business as

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelli Rene Fowles, DMD

  • Dentist
  • Bend, OR
  • NPI 1427364439

  General Practice

  NPD (past)
• David Allen Fuller, D.M.D.

  • General Practice Dentistry
  • Bend, OR
  • NPI 1275590101
  NPD (past)
• Mary Kathleen Grady, DDS

  • General Practice Dentistry
  • Redmond, OR
  • NPI 1447790837
  NPD (past)
• Hailey Renae Rambo, BS, RDH, EPDH

  • Dental Hygienist
  • Bend, OR
  • NPI 1932530458
  NPD (past)

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

{
    "created_epoch": "1332374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529884800000",
    "number": "1518233667",
    "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": "97701",
            "telephone_number": "541-388-1434",
            "fax_number": "541-388-1293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAYLOR C. FOWLES, DMD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-22",
        "last_updated": "2018-06-25",
        "status": "A",
        "authorized_official_last_name": "JOLLIFFE",
        "authorized_official_first_name": "ALECIA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "541-388-1434",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON DENTAL LICENSE",
            "identifier": "D10810",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON DENTAL LICENSE",
            "identifier": "D9910",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON DENTAL LICENSE",
            "identifier": "D9948",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Bend Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "East Bend Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amy Bidwell Tatom, APRN-NP
• Oliver Tatom, RN
• Robyn Leah Tatom, LCSW
• Bethany M Tatum
• Dayna Taus
• Heather Taylor-Martin
• Chelsea Ann Taylor
• David C Taylor, CRM
• Deborah Taylor, MCOUN
• James L Taylor, MD

• General Practice Dentistry in Bend, OR
• Providers in Bend, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.