Provider Demographics
NPI:1083644926
Name:OWENS, PAUL KEVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KEVIN
Last Name:OWENS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 E VICTOR HUGO AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4909
Mailing Address - Country:US
Mailing Address - Phone:602-789-9059
Mailing Address - Fax:
Practice Address - Street 1:11001 N 99TH AVE STE 113
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-5401
Practice Address - Country:US
Practice Address - Phone:623-583-7075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice