Provider Demographics
NPI:1205059482
Name:OWOC, KEVIN JAMES (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JAMES
Last Name:OWOC
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PAINTER ST
Mailing Address - Street 2:
Mailing Address - City:TRAFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15085-1333
Mailing Address - Country:US
Mailing Address - Phone:412-980-3206
Mailing Address - Fax:
Practice Address - Street 1:117 FOX RD
Practice Address - Street 2:SUITE # 202
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2723
Practice Address - Country:US
Practice Address - Phone:412-373-1999
Practice Address - Fax:412-373-2030
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS035508122300000X
MA21473122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist