Provider Demographics
NPI:1730797119
Name:OWENS, JARVIS B (DDS)
Entity type:Individual
Prefix:DR
First Name:JARVIS
Middle Name:B
Last Name:OWENS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17300 EL CAMINO REAL STE 101A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2743
Mailing Address - Country:US
Mailing Address - Phone:281-488-8463
Mailing Address - Fax:
Practice Address - Street 1:17300 EL CAMINO REAL STE 101A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2743
Practice Address - Country:US
Practice Address - Phone:281-488-8463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0328271223G0001X
TX38347122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice