Provider Demographics
NPI:1700870714
Name:OWEN, VIRGINIA CHERYL
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:CHERYL
Last Name:OWEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:VIRGINIA
Other - Middle Name:CHERYL
Other - Last Name:POE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:113 E. 2ND ST
Mailing Address - City:HARDINSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40143-0549
Mailing Address - Country:US
Mailing Address - Phone:270-756-5792
Mailing Address - Fax:270-756-5729
Practice Address - Street 1:113 E 2ND ST
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143-2609
Practice Address - Country:US
Practice Address - Phone:270-756-5792
Practice Address - Fax:270-756-5729
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY61531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60061538Medicaid