Healthcare Provider Details

I. General information

NPI: 1073447165
Provider Name (Legal Business Name): MATTHEW OWENS DMD
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 GRELOT RD STE B
MOBILE AL
36609-3606
US

IV. Provider business mailing address

6425 JORDAN RD
DAPHNE AL
36526-4728
US

V. Phone/Fax

Practice location:
  • Phone: 251-343-5974
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD.007647-C1
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: