Provider Demographics
NPI:1093867632
Name:OWENS, WENTZEL WRIGHT JR (DDS)
Entity Type:Individual
Prefix:MR
First Name:WENTZEL
Middle Name:WRIGHT
Last Name:OWENS
Suffix:JR
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 1:349 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WHITELAND
Mailing Address - State:IN
Mailing Address - Zip Code:46184-1514
Mailing Address - Country:US
Mailing Address - Phone:317-535-4877
Mailing Address - Fax:317-535-4877
Practice Address - Street 1:349 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184-1514
Practice Address - Country:US
Practice Address - Phone:317-535-4877
Practice Address - Fax:317-535-4877
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007642A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice