Provider Demographics
NPI:1639496219
Name:OWENS, STACI (RDA)
Entity Type:Individual
Prefix:MRS
First Name:STACI
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 WINDERMERE PKWY
Mailing Address - Street 2:SUITE 501
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6103
Mailing Address - Country:US
Mailing Address - Phone:770-889-9600
Mailing Address - Fax:770-888-0012
Practice Address - Street 1:3810 WINDERMERE PKWY
Practice Address - Street 2:SUITE 501
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6103
Practice Address - Country:US
Practice Address - Phone:770-889-9600
Practice Address - Fax:770-888-0012
Is Sole Proprietor?:No
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant