Provider Demographics
NPI:1962283564
Name:OWENS DENTAL BERTHOUD, P.C.
Entity type:Organization
Organization Name:OWENS DENTAL BERTHOUD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-631-6977
Mailing Address - Street 1:509 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-5016
Mailing Address - Country:US
Mailing Address - Phone:970-444-5464
Mailing Address - Fax:
Practice Address - Street 1:509 7TH ST
Practice Address - Street 2:
Practice Address - City:BERTHOUD
Practice Address - State:CO
Practice Address - Zip Code:80513-5016
Practice Address - Country:US
Practice Address - Phone:970-444-5464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental