Healthcare Provider Details

I. General information

NPI: 1376772137
Provider Name (Legal Business Name): RYAN MICHAEL OWASKI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11382 PROSPERITY FARMS RD STE 129
PALM BEACH GARDENS FL
33410-3463
US

IV. Provider business mailing address

272 FEATHER PT S
JUPITER FL
33458-8346
US

V. Phone/Fax

Practice location:
  • Phone: 561-622-9601
  • Fax:
Mailing address:
  • Phone: 917-445-7835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN 18578
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: