Healthcare Provider Details

I. General information

NPI: 1740720101
Provider Name (Legal Business Name): CLAYTON L OWEN DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 S PINE ST
CABOT AR
72023-3812
US

IV. Provider business mailing address

1306 S PINE ST
CABOT AR
72023-3812
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 LEE OWEN
Title or Position: OWNER
Credential: DDS
Phone: 501-941-1700