1699209890 NPI number — OWENS FAMILY DENTAL CARE LLC

Table of content: (NPI 1699209890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699209890 NPI number — OWENS FAMILY DENTAL CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OWENS FAMILY DENTAL CARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RICHARD L OWENS
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699209890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
124 LONGVIEW DR
Provider Second Line Business Mailing Address:
SUITE 8
Provider Business Mailing Address City Name:
DESTREHAN
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70047-5077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-764-1615
Provider Business Mailing Address Fax Number:
985-764-1617

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 LONGVIEW DR
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
DESTREHAN
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70047-5077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-764-1615
Provider Business Practice Location Address Fax Number:
985-764-1617
Provider Enumeration Date:
04/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
OWENS
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
985-764-1615

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  3633 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1235204835 . This is a "INDIVIDUAL PROVIDER NPI FOR RICHARD L OWENS DDS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1245639319 . This is a "INDIVIDUAL PROVIDER NPI FOR REID M OWENS DDS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1836338 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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