Provider Demographics
NPI:1699209890
Name:OWENS FAMILY DENTAL CARE LLC
Entity Type:Organization
Organization Name:OWENS FAMILY DENTAL CARE LLC
Other - Org Name:RICHARD L OWENS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-764-1615
Mailing Address - Street 1:124 LONGVIEW DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:DESTREHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70047-5077
Mailing Address - Country:US
Mailing Address - Phone:985-764-1615
Mailing Address - Fax:985-764-1617
Practice Address - Street 1:124 LONGVIEW DR
Practice Address - Street 2:SUITE 8
Practice Address - City:DESTREHAN
Practice Address - State:LA
Practice Address - Zip Code:70047-5077
Practice Address - Country:US
Practice Address - Phone:985-764-1615
Practice Address - Fax:985-764-1617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3633122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1235204835OtherINDIVIDUAL PROVIDER NPI FOR RICHARD L OWENS DDS
LA1245639319OtherINDIVIDUAL PROVIDER NPI FOR REID M OWENS DDS
LA1836338Medicaid