Provider Demographics
NPI:1780879031
Name:OWEN, R. KENT (DDS)
Entity type:Individual
Prefix:DR
First Name:R.
Middle Name:KENT
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 1:4269 W M-80
Mailing Address - Street 2:CHIPPEWA CORRECTIONAL FACILITY
Mailing Address - City:KINCHELOE
Mailing Address - State:MI
Mailing Address - Zip Code:49784-0001
Mailing Address - Country:US
Mailing Address - Phone:906-495-2275
Mailing Address - Fax:
Practice Address - Street 1:4269 W M-80
Practice Address - Street 2:CHIPPEWA CORRECTIONAL FACILITY
Practice Address - City:KINCHELOE
Practice Address - State:MI
Practice Address - Zip Code:49784-0001
Practice Address - Country:US
Practice Address - Phone:906-495-2275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016771122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice