Provider Demographics
NPI:1275627572
Name:OWENS, JAY ROSAMOND JR (DDS)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:ROSAMOND
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 1:1123 S UNIVERSITY AVE
Mailing Address - Street 2:SUITE 714
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-1614
Mailing Address - Country:US
Mailing Address - Phone:501-666-5412
Mailing Address - Fax:501-975-6261
Practice Address - Street 1:1123 S UNIVERSITY AVE
Practice Address - Street 2:SUITE 714
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-1614
Practice Address - Country:US
Practice Address - Phone:501-666-5412
Practice Address - Fax:501-975-6261
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR20901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58546OtherBCBS
AR80341OtherDELTA DENTAL