Provider Demographics
NPI:1356535876
Name:OWENS, WALTER RUSSELL III (DDS)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:RUSSELL
Last Name:OWENS
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:532 TURTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5617
Mailing Address - Country:US
Mailing Address - Phone:615-293-2957
Mailing Address - Fax:615-221-9891
Practice Address - Street 1:617 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-4211
Practice Address - Country:US
Practice Address - Phone:615-256-2321
Practice Address - Fax:615-221-9891
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5622OtherTENNCARE