MEDICARE: DR. CANDICE HENLEY OWENS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	22880	TX

General Provider Information

NPI Number	:	1609925064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CANDICE HENLEY OWENS D.D.S.

Provider Business Mailing Address
First Line	:	24434 FLINT CRK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78255-2290
Country	:	US
Telephone Number	:	210-845-9423
Fax Number	:

Provider Business Practice Location Address
First Line	:	4315 MOONLIGHT WAY
Second Line	:	SUITE 101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-1688
Country	:	US
Telephone Number	:	210-697-7377
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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