Healthcare Provider Details

I. General information

NPI: 1639330459
Provider Name (Legal Business Name): JESSICA OWENS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 FLORIDA AVE DEPT OF PERIODONTICS
NEW ORLEANS LA
70119-2714
US

IV. Provider business mailing address

1100 FLORIDA AVE DEPT OF ADVANCED EDUCATION AND HOSPITALS
NEW ORLEANS LA
70119-2714
US

V. Phone/Fax

Practice location:
  • Phone: 504-941-8113
  • Fax: 504-941-8115
Mailing address:
  • Phone: 504-941-8113
  • Fax: 504-941-8115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number5977
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: