Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 22219 | TX |
Y | 1223E0200X | Endodontist | 5754 | NV |
NPI | 1063605806 |
---|---|
Provider Name | Christopher Brett Owatz |
First Address | Las Vegas, NV 89106 |
Second Address | Las Vegas, NV 89106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2007 |
Last Update Date | 24/08/2007 |