Provider Demographics
NPI:1891334439
Name:DYKES, OWEN
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:
Last Name:DYKES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1387 CONGRESS ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-5067
Mailing Address - Country:US
Mailing Address - Phone:317-608-7654
Mailing Address - Fax:
Practice Address - Street 1:1319 CONGRESS ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-5064
Practice Address - Country:US
Practice Address - Phone:240-556-3843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant