Provider Demographics
NPI:1316203987
Name:OWENS, MARNI DROBNY
Entity Type:Individual
Prefix:
First Name:MARNI
Middle Name:DROBNY
Last Name:OWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 W MAPLE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-5803
Mailing Address - Country:US
Mailing Address - Phone:269-343-7811
Mailing Address - Fax:269-343-2810
Practice Address - Street 1:1011 W MAPLE ST STE 300
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-5803
Practice Address - Country:US
Practice Address - Phone:269-343-7811
Practice Address - Fax:269-343-2810
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-08
Last Update Date:2012-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902015930124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist