Active NPI
Taylor Fowles, DMD
- Dentist
- Bend, OR
National Provider Identifier
1740549898
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D9910
- Practice address
- 2250 NE Professional CT
Bend, OR 97701-6063 - Phone
- (541) 325-1243
- NPI assigned
- May 10, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D9910 | OR | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
2250 NE Professional CT
Bend, OR 97701-6063
Mailing address
2250 NE Professional CT
Bend, OR 97701-6063
Phone (541) 325-1243
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 |
|---|---|---|---|---|
| I20160120002691 | OR | Order and Referring Only - Oral Surgery | 3678876901 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D9910 | OR | MD | Dentist |
| 9910 | OR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1336608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1451260800000",
"number": "1740549898",
"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": "541-325-1243"
},
{
"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": "541-325-1243"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOWLES",
"first_name": "TAYLOR",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-05-10",
"last_updated": "2015-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D9910",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"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 Dec 28, 2015; 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.