Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 8538 | CO |
NPI | 1013161124 |
---|---|
Provider Name | Dr. Justin Michael Owens |
First Address | Denver, CO 80246-2408 |
Second Address | Denver, CO 80246-2408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2008 |
Last Update Date | 17/11/2008 |