Provider Demographics
NPI:1093073470
Name:OWENS, DENNIS CORNELIUS
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:CORNELIUS
Last Name:OWENS
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 1:2755 W CHEYENNE AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-3831
Mailing Address - Country:US
Mailing Address - Phone:702-762-4620
Mailing Address - Fax:702-868-6366
Practice Address - Street 1:2755 W CHEYENNE AVE STE 105
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-3831
Practice Address - Country:US
Practice Address - Phone:702-762-4620
Practice Address - Fax:702-868-6366
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner