Provider Demographics
NPI:1336212349
Name:OWEN, ROBERT H (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:OWEN
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 VINTAGE WAY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-6691
Mailing Address - Country:US
Mailing Address - Phone:334-277-6690
Mailing Address - Fax:334-277-6721
Practice Address - Street 1:2600 BELL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-4375
Practice Address - Country:US
Practice Address - Phone:334-277-6690
Practice Address - Fax:334-277-6721
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL51991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL770948OtherUNITED CONCORDIA