Provider Demographics
NPI:1770513947
Name:OWOCKI, DAVID DENNIS (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:DENNIS
Last Name:OWOCKI
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 1:219 WEST ROBERTS STREET
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2634
Mailing Address - Country:US
Mailing Address - Phone:810-629-2121
Mailing Address - Fax:810-629-8942
Practice Address - Street 1:219 WEST ROBERTS STREET
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2634
Practice Address - Country:US
Practice Address - Phone:810-629-2121
Practice Address - Fax:810-629-8942
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010153441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice