Provider Demographics
NPI:1699899823
Name:OWSLEY, TODD GENE (DDS MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:GENE
Last Name:OWSLEY
Suffix:
Gender:M
Credentials:DDS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 OAKCREST AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-1933
Mailing Address - Country:US
Mailing Address - Phone:336-288-0677
Mailing Address - Fax:336-288-0784
Practice Address - Street 1:2516 OAKCREST AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-1933
Practice Address - Country:US
Practice Address - Phone:336-288-0677
Practice Address - Fax:336-288-0784
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34801204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-9656YOtherNC MEDICAID DENTAL
NC0180TOtherBLUE CROSS BLUE SHIELD
NC8964709Medicaid
F35871Medicare UPIN
NC0180TOtherBLUE CROSS BLUE SHIELD