Healthcare Provider Details

I. General information

NPI: 1306950084
Provider Name (Legal Business Name): DANIEL WESLEY KAYLOR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46314 TIMINE WAY
PENDLETON OR
97801
US

IV. Provider business mailing address

46314 TIMINE WAY
PENDLETON OR
97801
US

V. Phone/Fax

Practice location:
  • Phone: 541-966-9830
  • Fax:
Mailing address:
  • Phone: 541-966-9830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5718
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: