Provider Demographics
NPI:1235318957
Name:HOWARD FAMILY DENTAL-PICKNEY COLONY, LLC
Entity Type:Organization
Organization Name:HOWARD FAMILY DENTAL-PICKNEY COLONY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:912-629-9001
Mailing Address - Street 1:10 PINCKNEY COLONY RD
Mailing Address - Street 2:BUILDING 500, SUITE 201
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-4126
Mailing Address - Country:US
Mailing Address - Phone:843-815-9798
Mailing Address - Fax:
Practice Address - Street 1:10 PINCKNEY COLONY RD
Practice Address - Street 2:BUILDING 500, SUITE 201
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-4126
Practice Address - Country:US
Practice Address - Phone:843-815-9798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty