Provider Demographics
NPI:1184998981
Name:OWENS, ROBERT M (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:OWENS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 S PEARSON RD
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-5907
Mailing Address - Country:US
Mailing Address - Phone:601-939-2377
Mailing Address - Fax:601-939-2529
Practice Address - Street 1:642 S PEARSON RD
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-5907
Practice Address - Country:US
Practice Address - Phone:601-939-2377
Practice Address - Fax:601-939-2529
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3011-971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice