Healthcare Provider Details

I. General information

NPI: 1174441463
Provider Name (Legal Business Name): BLAIR OWENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3722 CEDAR HEIGHTS DR
CEDAR FALLS IA
50613-6207
US

IV. Provider business mailing address

3722 CEDAR HEIGHTS DR
CEDAR FALLS IA
50613-6207
US

V. Phone/Fax

Practice location:
  • Phone: 319-266-7559
  • Fax:
Mailing address:
  • Phone: 319-266-7559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS-10522
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: