Healthcare Provider Details

I. General information

NPI: 1013161124
Provider Name (Legal Business Name): JUSTIN MICHAEL OWENS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 S COLORADO BLVD STE 102
DENVER CO
80246-2408
US

IV. Provider business mailing address

965 S COLORADO BLVD STE 102
DENVER CO
80246-2408
US

V. Phone/Fax

Practice location:
  • Phone: 303-744-1701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8538
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: