Healthcare Provider Details

I. General information

NPI: 1073726261
Provider Name (Legal Business Name): CLAYTON L OWEN DDS MS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 SOUTH PINE STREET SUITE B
CABOT AR
72023
US

IV. Provider business mailing address

1106 SOUTH PINE STREET SUITE B
CABOT AR
72023
US

V. Phone/Fax

Practice location:
  • Phone: 501-941-1700
  • Fax: 501-941-1703
Mailing address:
  • Phone: 501-941-1700
  • Fax: 501-941-1703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3461
License Number StateAR

VIII. Authorized Official

Name: DR. CLAYTON L OWEN
Title or Position: OWEN
Credential: DDS
Phone: 501-941-1700