Healthcare Provider Details

I. General information

NPI: 1205193117
Provider Name (Legal Business Name): SEAN CHRISTOPHER OWENS D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40470 GERMANY RD
GONZALES LA
70737-6735
US

IV. Provider business mailing address

1020 DAISY AVE
SAINT GABRIEL LA
70776-5127
US

V. Phone/Fax

Practice location:
  • Phone: 225-622-2022
  • Fax:
Mailing address:
  • Phone: 225-241-9068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6183
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: