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General NPI Number Information
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NPI Number | 1447320890
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Entity Type | Individual
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Provider Name | WILLIAM D. OWEN JR. D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 07/08/2007
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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 | PO BOX 425
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-0425
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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 |
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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 | 0401004909
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License Number State | VA
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