Provider Demographics
NPI:1972848562
Name:RENEE L.I. OWEN DDS PC
Entity Type:Organization
Organization Name:RENEE L.I. OWEN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:LI
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-543-5230
Mailing Address - Street 1:2024 LANSING RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-8419
Mailing Address - Country:US
Mailing Address - Phone:517-543-5230
Mailing Address - Fax:
Practice Address - Street 1:2024 LANSING RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-8419
Practice Address - Country:US
Practice Address - Phone:517-543-5230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010198511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty