Healthcare Provider Details

I. General information

NPI: 1891537809
Provider Name (Legal Business Name): BRENDAN OWINGS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 WAKARUSA DR STE A
LAWRENCE KS
66049-3246
US

IV. Provider business mailing address

PO BOX 273
BALDWIN CITY KS
66006-0273
US

V. Phone/Fax

Practice location:
  • Phone: 785-256-9092
  • Fax:
Mailing address:
  • Phone: 785-979-1363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number62145
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: