Provider Demographics
NPI:1275832610
Name:HOWELL, BRENDA SUE (DA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:SUE
Last Name:HOWELL
Suffix:
Gender:F
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13882 S HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-2829
Mailing Address - Country:US
Mailing Address - Phone:918-855-0240
Mailing Address - Fax:
Practice Address - Street 1:1044 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4505
Practice Address - Country:US
Practice Address - Phone:918-224-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5291126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant