Healthcare Provider Details

I. General information

NPI: 1174174577
Provider Name (Legal Business Name): OWEN DENSEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE # MLC5043
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-803-0011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.08307
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberLD.08307
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: