Provider Demographics
NPI:1629036371
Name:OWEN, BENJAMIN DANIEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DANIEL
Last Name:OWEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3599 WINFIELD SCOTT RD
Mailing Address - Street 2:SUITE 3401
Mailing Address - City:JBSA FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234
Mailing Address - Country:US
Mailing Address - Phone:210-221-8982
Mailing Address - Fax:
Practice Address - Street 1:3599 WINFIELD SCOTT RD
Practice Address - Street 2:SUITE 3401
Practice Address - City:JBSA FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234
Practice Address - Country:US
Practice Address - Phone:210-221-8982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD65711223G0001X
CA564671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice