Provider Demographics
NPI:1811125461
Name:OWEN, JONATHAN TREY (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:TREY
Last Name:OWEN
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 1:101 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-2783
Mailing Address - Country:US
Mailing Address - Phone:308-432-5559
Mailing Address - Fax:308-432-5902
Practice Address - Street 1:101 E 6TH ST
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-2783
Practice Address - Country:US
Practice Address - Phone:308-432-5559
Practice Address - Fax:308-432-5902
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6809122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist