Provider Demographics
NPI:1427010719
Name:OWENS, JAY ROSAMOND III (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:ROSAMOND
Last Name:OWENS
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JAY
Other - Middle Name:ROSAMOND
Other - Last Name:OWENS
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3600 SHOEMAKER DRIVE, SUITE 1052
Mailing Address - Street 2:
Mailing Address - City:FT. CAVAZOS
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:254-287-8887
Mailing Address - Fax:
Practice Address - Street 1:36000 SHOEMAKER LANE
Practice Address - Street 2:
Practice Address - City:FT CAVAZOS
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-287-8887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78461223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223G0001XDental ProvidersDentistGeneral Practice