Provider Demographics
NPI:1295920155
Name:ATKIN, OWEN L (DMD)
Entity type:Individual
Prefix:
First Name:OWEN
Middle Name:L
Last Name:ATKIN
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 1:965 W VICTORY WAY
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81625-2937
Mailing Address - Country:US
Mailing Address - Phone:970-824-3425
Mailing Address - Fax:
Practice Address - Street 1:965 W VICTORY WAY
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-2937
Practice Address - Country:US
Practice Address - Phone:970-824-3425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10180122300000X
ORD8966122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist