Healthcare Provider Details

I. General information

NPI: 1679436745
Provider Name (Legal Business Name): OWENS DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 E 4TH AVE
AFTON WY
83110
US

IV. Provider business mailing address

PO BOX 609
AFTON WY
83110-0609
US

V. Phone/Fax

Practice location:
  • Phone: 307-885-5276
  • Fax:
Mailing address:
  • Phone: 307-885-5276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEGAN P OWENS
Title or Position: OFFICE MANAGER
Credential: RDH
Phone: 307-248-1255