Individual
JEREL NATHANIEL OWENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
15400 W MCNICHOLS RD, DETROIT, MI 48235-3724
(313) 835-5990
(313) 835-5920
Mailing address
15400 W MCNICHOLS RD, DETROIT, MI 48235-3724
(313) 835-5990
(313) 835-5920
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901011444
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11293190
CAQH
MI
05
—
4718431
—
MI
01
—
88183
DELTA DENTAL
MI
Enumeration date
08/16/2006
Last updated
12/15/2022
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