Individual
DR. MATHEW OWENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
87 S BURNT MILL RD, LA FAYETTE, GA 30728-4263
(706) 620-4494
(706) 657-2958
Mailing address
13570 N MAIN ST, TRENTON, GA 30752-2012
(706) 956-2665
(706) 657-2958
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN015015
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003168798A
—
GA
05
—
003168798B
—
GA
05
—
003168798C
—
GA
Enumeration date
07/10/2015
Last updated
11/05/2015
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