Provider Demographics
NPI:1225195803
Name:OVENS, MICHAEL L (DDS MSD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:OVENS
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14640 N TATUM BLVD #5
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4824
Mailing Address - Country:US
Mailing Address - Phone:602-992-7182
Mailing Address - Fax:602-992-0157
Practice Address - Street 1:14640 N TATUM BLVD #5
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4824
Practice Address - Country:US
Practice Address - Phone:602-992-7182
Practice Address - Fax:602-992-0157
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16531223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics