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General NPI Number Information
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NPI Number | 1356535876
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Entity Type | Individual
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Provider Name | WALTER RUSSELL OWENS III D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 08/28/2007
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Provider Practice Location Address
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Address Line | 617 WOODLAND ST
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City | NASHVILLE
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State | TN
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Zip | 37206-4211
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Country | US
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Telephone | 615-256-2321
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Fax | 615-221-9891
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Provider Business Mailing Address
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Address Line | 532 TURTLE CREEK DR
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City | BRENTWOOD
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State | TN
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Zip | 37027-5617
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Country | US
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Telephone | 615-293-2957
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Fax | 615-221-9891
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 3526
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License Number State | TN
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