=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477753630
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAUL KEVIN OWENS DDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2007
-----------------------------------------------------
Last Update Date | 07/24/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11001 N 99TH AVE STE 113
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85345-5401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-583-7075
-----------------------------------------------------
Fax | 623-523-0413
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11001 N 99TH AVE STE 113
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85345-5401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-583-7075
-----------------------------------------------------
Fax | 623-523-0413
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. PAUL KEVIN OWENS
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 623-583-7075
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 4630
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------