Healthcare Provider Details

I. General information

NPI: 1003559386
Provider Name (Legal Business Name): KATELYN MILLER OWEN DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 FREDERICK RD FL 2FLO2
CATONSVILLE MD
21228-4856
US

IV. Provider business mailing address

412 SAMANTHAS CT
REISTERSTOWN MD
21136-6435
US

V. Phone/Fax

Practice location:
  • Phone: 410-744-2230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number17184
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: