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General NPI Number Information
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NPI Number | 1841343308
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Entity Type | Organization
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Legal Business Name | KENNETH D. OWEN, DDS, PA
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 497 N WENDOVER RD
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City | CHARLOTTE
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State | NC
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Zip | 28211-1064
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Country | US
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Telephone | 704-366-8006
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Fax | 704-364-9390
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Provider Business Mailing Address
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Address Line | 497 N WENDOVER RD
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City | CHARLOTTE
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State | NC
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Zip | 28211-1064
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Country | US
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Telephone | 704-366-8006
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Fax | 704-364-9390
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. KENNETH DALE OWEN SR.
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Credential | D.D.S., M.SC.O.
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Telephone | 704-366-8006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2908
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License Number State | NC
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