Provider Demographics
NPI:1427401363
Name:OWENS, ROSS CLARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:CLARK
Last Name:OWENS
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 1:201 MERCADO ST
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7301
Mailing Address - Country:US
Mailing Address - Phone:970-259-1646
Mailing Address - Fax:
Practice Address - Street 1:201 MERCADO ST
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7301
Practice Address - Country:US
Practice Address - Phone:970-259-1646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00202879122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist