Tayler Ray Pennington, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11753 Issued in OR

Practice address

63455 N Hwy 97 Ste 13
Bend, OR 97703-5724

Phone

(458) 320-2681

NPI assigned

Jun 8, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Tayler Schartz Former name

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: tschartzbruce298099@direct.phhs.org

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

{
    "created_epoch": "1623110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736294400000",
    "number": "1811564941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63143 OB RILEY RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977039003",
            "telephone_number": "541-588-2040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63455 N HWY 97 STE 13",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977035724",
            "telephone_number": "458-320-2681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNINGTON",
        "first_name": "TAYLER",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-08",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D11753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAYLER",
            "last_name": "SCHARTZ",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Annette L Pelletier, LCSW
• Anne L Pendygraft
• Phyllis A Pengelly, WHNP
• Laura Kay Pennavaria, MD
• Margaret Pennington
• Katharine Pentz
• John Denton Peoples, M.D.
• Breanna Loreen Percell, MD
• Jonathan Perera
• Alejandrina Perez

• 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 Jan 8, 2025; 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.

Verify at the official NPI Registry.