Healthcare Provider Details

I. General information

NPI: 1801915558
Provider Name (Legal Business Name): RODNEY L. OWEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 TERRACINA BLVD SUITE 209B
REDLANDS CA
92373-4852
US

IV. Provider business mailing address

245 TERRACINA BLVD SUITE 209B
REDLANDS CA
92373-4852
US

V. Phone/Fax

Practice location:
  • Phone: 909-798-4336
  • Fax:
Mailing address:
  • Phone: 909-798-4336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number27182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: