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General NPI Number Information
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NPI Number | 1811564941
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Entity Type | Individual
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Provider Name | TAYLER RAY PENNINGTON DDS
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Gender | Male
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Dates
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Enumeration Date | 06/08/2021
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 63455 N HWY 97 STE 13
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City | BEND
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State | OR
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Zip | 97703-5724
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Country | US
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Telephone | 458-320-2681
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Fax |
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Provider Business Mailing Address
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Address Line | 63143 OB RILEY RD
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City | BEND
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State | OR
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Zip | 97703-9003
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Country | US
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Telephone | 541-588-2040
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D11753
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License Number State | OR
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