Provider Demographics
NPI:1770738320
Name:STEVEN R OWENS, DDS, PC
Entity type:Organization
Organization Name:STEVEN R OWENS, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-865-2780
Mailing Address - Street 1:PO BOX 1535
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85533-1535
Mailing Address - Country:US
Mailing Address - Phone:928-865-2780
Mailing Address - Fax:
Practice Address - Street 1:#1 N. CORONADO BLVD.
Practice Address - Street 2:SUITE #C
Practice Address - City:CLIFTON
Practice Address - State:AZ
Practice Address - Zip Code:85546
Practice Address - Country:US
Practice Address - Phone:928-865-2780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2541261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental