Provider Demographics
NPI:1538906888
Name:OWIESY, SHERWIN (DMD)
Entity type:Individual
Prefix:
First Name:SHERWIN
Middle Name:
Last Name:OWIESY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22027 N 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5295
Mailing Address - Country:US
Mailing Address - Phone:951-870-9085
Mailing Address - Fax:
Practice Address - Street 1:3400 LOMA VISTA RD STE 10
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3060
Practice Address - Country:US
Practice Address - Phone:805-654-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-12
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0122651223G0001X
CADDS1110111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice