Provider Demographics
NPI:1548482227
Name:OWENS, DEVERT JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:DEVERT
Middle Name:JOSEPH
Last Name:OWENS
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 1:131 CHERRYBARK DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1803
Mailing Address - Country:US
Mailing Address - Phone:859-277-6678
Mailing Address - Fax:859-278-9180
Practice Address - Street 1:131 CHERRYBARK DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1803
Practice Address - Country:US
Practice Address - Phone:859-277-6678
Practice Address - Fax:859-278-9180
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY62761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60062767Medicaid