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General NPI Number Information
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NPI Number | 1043357924
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Entity Type | Organization
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Legal Business Name | WILLIAM D. OWEN, JR.,DDS & DEBRA G. CLAYCOMB,DDS, PLLC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 431 MAIN ST
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-3241
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Country | US
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Telephone | 434-572-3205
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Fax | 434-572-8566
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Provider Business Mailing Address
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Address Line | 431 MAIN ST P. O. BOX 425
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-3241
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Country | US
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Telephone | 434-572-3205
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Fax | 434-572-8566
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Authorized Official
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Title or Position | PART OWNER
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Name | DR. WILLIAM D. OWEN JR.
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Credential | D.D.S.
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Telephone | 434-572-3205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401004909
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License Number State | VA
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