Provider Demographics
NPI:1073726261
Name:CLAYTON L OWEN DDS MS PLLC
Entity Type:Organization
Organization Name:CLAYTON L OWEN DDS MS PLLC
Other - Org Name:OWEN ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWEN
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:L
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-941-1700
Mailing Address - Street 1:1106 SOUTH PINE STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023
Mailing Address - Country:US
Mailing Address - Phone:501-941-1700
Mailing Address - Fax:501-941-1703
Practice Address - Street 1:1106 SOUTH PINE STREET
Practice Address - Street 2:SUITE B
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023
Practice Address - Country:US
Practice Address - Phone:501-941-1700
Practice Address - Fax:501-941-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR34611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty