Healthcare Provider Details

I. General information

NPI: 1538906888
Provider Name (Legal Business Name): SHERWIN OWIESY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 LOMA VISTA RD STE 10
VENTURA CA
93003-3060
US

IV. Provider business mailing address

22027 N 73RD AVE
GLENDALE AZ
85310-5295
US

V. Phone/Fax

Practice location:
  • Phone: 805-654-1700
  • Fax:
Mailing address:
  • Phone: 951-870-9085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD012265
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS111011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: