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General NPI Number Information
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NPI Number | 1518233667
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Entity Type | Organization
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Legal Business Name | TAYLOR C. FOWLES, DMD, LLC
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Dates
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Enumeration Date | 03/22/2012
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 2250 NE PROFESSIONAL CT
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City | BEND
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State | OR
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Zip | 97701
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Country | US
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Telephone | 541-388-1434
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Fax | 541-388-1293
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Provider Business Mailing Address
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Address Line | 2250 NE PROFESSIONAL CT
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City | BEND
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State | OR
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Zip | 97701-6063
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Country | US
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Telephone | 541-388-1434
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Fax | 541-388-1293
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. ALECIA J JOLLIFFE
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Credential |
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Telephone | 541-388-1434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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