Provider Demographics
NPI:1063698397
Name:CHARLES C. OWENS, DDS, INC.
Entity type:Organization
Organization Name:CHARLES C. OWENS, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:CLINTON
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:580-248-6062
Mailing Address - Street 1:1316 NW FERRIS AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-6566
Mailing Address - Country:US
Mailing Address - Phone:580-248-6062
Mailing Address - Fax:580-248-6065
Practice Address - Street 1:1316 NW FERRIS AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-6566
Practice Address - Country:US
Practice Address - Phone:580-248-6062
Practice Address - Fax:580-248-6065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK34791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty