Provider Demographics
NPI:1013574359
Name:HOWELL, THERESE JEANNE (RDH)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:JEANNE
Last Name:HOWELL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 SANGUINETTI RD STE C
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-6210
Mailing Address - Country:US
Mailing Address - Phone:209-928-5400
Mailing Address - Fax:209-928-5414
Practice Address - Street 1:19969 GREENLEY RD STE C
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5908
Practice Address - Country:US
Practice Address - Phone:209-928-5400
Practice Address - Fax:209-928-5414
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH21440124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist