Active NPI
R. Kent Owen, D.D.S.
- Dentist
- Kincheloe, MI
National Provider Identifier
1780879031
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901016771
- Practice address
- 4269 W M-80
Chippewa Correctional Facility
Kincheloe, MI 49784-0001 - Phone
- (906) 495-2275
- NPI assigned
- Sep 10, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901016771 | MI | Primary |
| General Practice Dentistry | 1223G0001X | 2901016771 | MI |
Addresses
Primary practice location
4269 W M-80
Chippewa Correctional Facility
Kincheloe, MI 49784-0001
Mailing address
4269 W M-80
Chippewa Correctional Facility
Kincheloe, MI 49784-0001
Phone (906) 495-2275
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901016771 | MI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189382400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189382400000",
"number": "1780879031",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4269 W M-80",
"address_2": "CHIPPEWA CORRECTIONAL FACILITY",
"city": "KINCHELOE",
"state": "MI",
"postal_code": "497840001",
"telephone_number": "906-495-2275"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4269 W M-80",
"address_2": "CHIPPEWA CORRECTIONAL FACILITY",
"city": "KINCHELOE",
"state": "MI",
"postal_code": "497840001",
"telephone_number": "906-495-2275"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OWEN",
"first_name": "R.",
"middle_name": "KENT",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-09-10",
"last_updated": "2007-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901016771",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MI",
"license": "2901016771",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kincheloe, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.