Healthcare Provider Details

I. General information

NPI: 1740621663
Provider Name (Legal Business Name): JASMIN NICOLE OWENS D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
JACKSON MS
39216-4500
US

IV. Provider business mailing address

2500 N STATE ST UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-6028
  • Fax:
Mailing address:
  • Phone: 601-984-6028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN014737
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: