Alfonzo Benjamin Owens III, D.M.D.

Key facts

NPI

1497833347

Entity type

Individual (NPI type 1)

Primary specialty

General Practice Dentistry 1223G0001X

License

034828 (NY)

Practice address

129 Halstead Ave
Suite 3
Mamaroneck, NY 10543-2619

Phone

(914) 698-1886

Fax

(914) 698-2894

NPI assigned

Nov 1, 2006

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Interoperability endpoints

• Direct secure messaging: aowens561690@nychhc.direct-ci.com

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497833347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 GARDEN AVE",
            "city": "MOUNT VERNON",
            "state": "NY",
            "postal_code": "105532016",
            "telephone_number": "914-699-2686",
            "fax_number": "914-699-2686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 HALSTEAD AVE",
            "address_2": "SUITE 3",
            "city": "MAMARONECK",
            "state": "NY",
            "postal_code": "105432619",
            "telephone_number": "914-698-1886",
            "fax_number": "914-698-2894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OWENS",
        "first_name": "ALFONZO",
        "middle_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "034828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Mamaroneck, NY · General Practice Dentistry in New York