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NPI Code Detail

MEDICARE: VIRGINIA FADELEY OWENS DMD

MEDICARE:   VIRGINIA FADELEY OWENS  DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry8099SC

General Provider Information

NPI Number : 1649535964
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIRGINIA FADELEY OWENS DMD
Provider Business Mailing Address
First Line : 3308 PLATT SPRINGS RD
Second Line :
City : WEST COLUMBIA
State : SC
Zip : 29170-2204
Country : US
Telephone Number : 803-360-3816
Fax Number :
Provider Business Practice Location Address
First Line : 3308 PLATT SPRINGS RD
Second Line :
City : WEST COLUMBIA
State : SC
Zip : 29170-2204
Country : US
Telephone Number : 803-360-3816
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2012
Last Update Date : 11/14/2024

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Directions to “ VIRGINIA FADELEY OWENS DMD” Practice Location

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