Provider Demographics
NPI:1609925064
Name:OWENS, CANDICE HENLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:HENLEY
Last Name:OWENS
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 1:24434 FLINT CRK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-2290
Mailing Address - Country:US
Mailing Address - Phone:210-845-9423
Mailing Address - Fax:
Practice Address - Street 1:4315 MOONLIGHT WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1688
Practice Address - Country:US
Practice Address - Phone:210-697-7377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX228801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice