Provider Demographics
NPI:1255569604
Name:OWEN, WILLIAM LAWRENCE IV (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LAWRENCE
Last Name:OWEN
Suffix:IV
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:PO BOX 1647
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29021-8647
Mailing Address - Country:US
Mailing Address - Phone:803-432-2155
Mailing Address - Fax:803-432-7744
Practice Address - Street 1:310 HAMPTON PARK
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-3605
Practice Address - Country:US
Practice Address - Phone:803-432-2155
Practice Address - Fax:803-432-7744
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC46231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice