Provider Demographics
NPI:1194788190
Name:OWENS, RUSSELL BENJAMIN COOPER (DDS)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:BENJAMIN COOPER
Last Name:OWENS
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 1:220 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-1351
Mailing Address - Country:US
Mailing Address - Phone:440-466-4884
Mailing Address - Fax:
Practice Address - Street 1:184 S BROADWAY
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-1805
Practice Address - Country:US
Practice Address - Phone:440-466-4884
Practice Address - Fax:440-466-0636
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50340122300000X
OH300227541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist