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General NPI Number Information
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NPI Number | 1588520894
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Entity Type | Organization
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Legal Business Name | AMBERENA L FAIRLEE DMD LLC
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Dates
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Enumeration Date | 12/30/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 361 NE FRANKLIN AVE BLDG D
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City | BEND
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State | OR
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Zip | 97701-4968
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Country | US
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Telephone | 541-382-5678
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Fax |
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Provider Business Mailing Address
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Address Line | 361 NE FRANKLIN AVE BLDG D
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City | BEND
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State | OR
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Zip | 97701-4968
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | DR. AMBERENA LOUISE FAIRLEE
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Credential | DMD
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Telephone | 541-977-7618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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