Provider Demographics
NPI:1487091443
Name:OWENS, DEREK STEPHEN (DDS, BS)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:STEPHEN
Last Name:OWENS
Suffix:
Gender:M
Credentials:DDS, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-2146
Mailing Address - Country:US
Mailing Address - Phone:303-349-6480
Mailing Address - Fax:
Practice Address - Street 1:3255 LOCUST ST.
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80207
Practice Address - Country:US
Practice Address - Phone:303-349-6480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO391223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry