Provider Demographics
NPI:1396230082
Name:OWEN, MCKENZIE FAYE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MCKENZIE
Middle Name:FAYE
Last Name:OWEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 N MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:AINSWORTH
Mailing Address - State:NE
Mailing Address - Zip Code:69210-1420
Mailing Address - Country:US
Mailing Address - Phone:402-387-2404
Mailing Address - Fax:
Practice Address - Street 1:255 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:AINSWORTH
Practice Address - State:NE
Practice Address - Zip Code:69210-1420
Practice Address - Country:US
Practice Address - Phone:402-387-2404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7488122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist