Provider Demographics
NPI:1134203862
Name:REDMAN-OWENS, JERA (DMD)
Entity type:Individual
Prefix:DR
First Name:JERA
Middle Name:
Last Name:REDMAN-OWENS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1746 HIGHWAY 44 E
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-6131
Mailing Address - Country:US
Mailing Address - Phone:502-955-7102
Mailing Address - Fax:502-531-9303
Practice Address - Street 1:1746 HIGHWAY 44 E
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-6131
Practice Address - Country:US
Practice Address - Phone:502-955-7102
Practice Address - Fax:502-531-9303
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7952OtherKY LICENSE