Provider Demographics
NPI:1821417700
Name:MICHAEL OWENS DDS OF WALDORF LLC
Entity Type:Organization
Organization Name:MICHAEL OWENS DDS OF WALDORF LLC
Other - Org Name:VIBRANT SMILES OF WALDORF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-645-5182
Mailing Address - Street 1:152A POST OFFICE RD
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2711
Mailing Address - Country:US
Mailing Address - Phone:301-645-5182
Mailing Address - Fax:
Practice Address - Street 1:152A POST OFFICE RD
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2711
Practice Address - Country:US
Practice Address - Phone:301-645-5182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty