Provider Demographics
NPI:1104193747
Name:OWEN, CASEY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:J
Last Name:OWEN
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 1:102 ERVIN DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-1081
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 ERVIN DR
Practice Address - Street 2:SUITE A
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-1081
Practice Address - Country:US
Practice Address - Phone:615-735-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000093201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice