Individual
TODD GENE OWSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MD
Contact information
Practice address
2516 OAKCREST AVENUE, SUITE B, GREENSBORO, NC 27408-1933
(336) 288-0677
(336) 288-0784
Mailing address
2516 OAKCREST AVENUE, SUITE B, GREENSBORO, NC 27408-1933
(336) 288-0677
(336) 288-0784
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
34801
NC
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
34801
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0180T
BLUE CROSS BLUE SHIELD
NC
01
—
89-9656Y
NC MEDICAID DENTAL
NC
05
—
8964709
—
NC
Enumeration date
03/16/2007
Last updated
01/26/2010
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