Provider Demographics
NPI:1053457424
Name:OWDOM, STEVEN LEE
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:LEE
Last Name:OWDOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 WEST COLUMBIA STREET
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-3906
Mailing Address - Country:US
Mailing Address - Phone:740-382-2569
Mailing Address - Fax:
Practice Address - Street 1:132 WEST COLUMBIA STREET
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-3906
Practice Address - Country:US
Practice Address - Phone:740-382-2569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH150791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice