Provider Demographics
NPI:1770590473
Name:OWEN, ALAN R (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
Last Name:OWEN
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 1:11300 SHASTA LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-2739
Mailing Address - Country:US
Mailing Address - Phone:405-722-9065
Mailing Address - Fax:
Practice Address - Street 1:7300 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-5726
Practice Address - Country:US
Practice Address - Phone:405-721-1616
Practice Address - Fax:405-728-5811
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK47641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice