Provider Demographics
NPI:1639199359
Name:OWENS, ROBERT WALTER (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WALTER
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 1:8045 S 700 E
Mailing Address - Street 2:SUITE #5
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-0534
Mailing Address - Country:US
Mailing Address - Phone:801-561-5191
Mailing Address - Fax:801-562-5344
Practice Address - Street 1:8045 S 700 E
Practice Address - Street 2:SUITE #5
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-0534
Practice Address - Country:US
Practice Address - Phone:801-561-5191
Practice Address - Fax:801-562-5344
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1348839922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist