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General NPI Number Information
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NPI Number | 1255415220
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Entity Type | Organization
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Legal Business Name | R MARK OWENS DMD PA
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 05/27/2011
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Provider Practice Location Address
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Address Line | 642 S PEARSON ROAD
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City | PEARL
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State | MS
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Zip | 39208
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Country | US
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Telephone | 601-939-2377
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Fax | 601-939-2529
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Provider Business Mailing Address
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Address Line | 642 S PEARSON ROAD
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City | PEARL
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State | MS
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Zip | 39208
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Country | US
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Telephone | 601-939-2377
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Fax | 601-939-2529
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT MARK OWENS
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Credential | DMD
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Telephone | 601-939-2377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 301197
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License Number State | MS
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