MEDICARE: KAYLA ALLEN BREYER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D11886	OR
2	1223G0001X	General Practice Dentistry	D11886	OR

General Provider Information

NPI Number	:	1093594863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA ALLEN BREYER DMD

Provider Business Mailing Address
First Line	:	63140 BRITTA ST STE D104
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-5738
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1355 EDGEWATER ST NW
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97304-4077
Country	:	US
Telephone Number	:	503-588-6960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2023
Last Update Date	:	04/09/2025

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Directions to “ KAYLA ALLEN BREYER DMD” Practice Location

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