Healthcare Provider Details

I. General information

NPI: 1164231619
Provider Name (Legal Business Name): KD ENDO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 NW SHEVLIN PARK RD STE 140
BEND OR
97703-7133
US

IV. Provider business mailing address

2225 NW SHEVLIN PARK RD STE 140
BEND OR
97703-7133
US

V. Phone/Fax

Practice location:
  • Phone: 844-929-3636
  • Fax:
Mailing address:
  • Phone: 844-929-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. DANIEL BITNER
Title or Position: OWNER/MANAGER
Credential: DMD
Phone: 541-255-9831