=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669642690
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RONALD T. OWENS DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2008
-----------------------------------------------------
Last Update Date | 06/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1304 MAIN AVE
-----------------------------------------------------
City | DURANGO
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81301-5139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-247-0331
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1304 MAIN AVE
-----------------------------------------------------
City | DURANGO
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81301-5139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-247-0331
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RONALD T OWENS
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 970-247-0331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 9446
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------