Provider Demographics
NPI:1164576484
Name:HOWELL, ELISE ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:ANN
Last Name:HOWELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6424 SAYE CUT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1919
Mailing Address - Country:US
Mailing Address - Phone:803-695-1608
Mailing Address - Fax:
Practice Address - Street 1:10 RICHLAND MEDICAL PARK DR
Practice Address - Street 2:DENTAL CENTER
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6892
Practice Address - Country:US
Practice Address - Phone:803-434-7565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9873Medicaid
SCU94978Medicare UPIN