Healthcare Provider Details

I. General information

NPI: 1770258840
Provider Name (Legal Business Name): ROLA OWIES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W BROADWAY
PATERSON NJ
07505-1014
US

IV. Provider business mailing address

1114 MAIN AVE # 45
CLIFTON NJ
07011-2331
US

V. Phone/Fax

Practice location:
  • Phone: 973-684-3803
  • Fax:
Mailing address:
  • Phone: 197-333-7744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02859000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: