Healthcare Provider Details

I. General information

NPI: 1245543685
Provider Name (Legal Business Name): ERIC M OWEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 N WELLS ST
EDNA TX
77957-2749
US

IV. Provider business mailing address

502 N WELLS ST
EDNA TX
77957-2749
US

V. Phone/Fax

Practice location:
  • Phone: 361-782-2223
  • Fax:
Mailing address:
  • Phone: 361-782-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS038365
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number34782
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: