Provider Demographics
NPI:1790951770
Name:JACK M. OWENS JR. DDS PC
Entity Type:Organization
Organization Name:JACK M. OWENS JR. DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:M
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-658-0089
Mailing Address - Street 1:5980 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-4029
Mailing Address - Country:US
Mailing Address - Phone:225-658-0089
Mailing Address - Fax:225-658-0789
Practice Address - Street 1:5980 MAIN ST
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-4029
Practice Address - Country:US
Practice Address - Phone:225-658-0089
Practice Address - Fax:225-658-0789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA40961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty