Provider Demographics
NPI:1174604862
Name:OWENS, THOMAS GLENN (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GLENN
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 1:505 REALTY STREET
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645
Mailing Address - Country:US
Mailing Address - Phone:828-754-2600
Mailing Address - Fax:828-754-2603
Practice Address - Street 1:505 REALTY STREET
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645
Practice Address - Country:US
Practice Address - Phone:828-754-2600
Practice Address - Fax:828-754-2603
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC42411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8996567Medicaid