Provider Demographics
NPI:1457386641
Name:OWENS, RONALD KEITH (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:KEITH
Last Name:OWENS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 WESTBROOK PLAZA DR
Mailing Address - Street 2:STE 201
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-765-8878
Mailing Address - Fax:336-765-4480
Practice Address - Street 1:1551 WESTBROOK PLAZA DR
Practice Address - Street 2:STE 201
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-765-8878
Practice Address - Fax:336-765-4480
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCG5981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
U62453Medicare UPIN
2428582AMedicare ID - Type Unspecified