Provider Demographics
NPI:1386658904
Name:HEARNE, OWEN BRADLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:OWEN
Middle Name:BRADLEY
Last Name:HEARNE
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 1:400 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:OK
Mailing Address - Zip Code:74728-2982
Mailing Address - Country:US
Mailing Address - Phone:580-584-3321
Mailing Address - Fax:580-584-3237
Practice Address - Street 1:400 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:OK
Practice Address - Zip Code:74728-2982
Practice Address - Country:US
Practice Address - Phone:580-584-3321
Practice Address - Fax:580-584-3237
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK35321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice