Healthcare Provider Details

I. General information

NPI: 1215022660
Provider Name (Legal Business Name): NICK S. OWINGS D.D.S. P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S. DRAKE ROAD
KALAMAZOO MI
49009
US

IV. Provider business mailing address

401 S. DRAKE ROAD
KALAMAZOO MI
49009
US

V. Phone/Fax

Practice location:
  • Phone: 269-344-1271
  • Fax: 269-344-0236
Mailing address:
  • Phone: 269-344-1271
  • Fax: 269-344-0236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number11654
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: