Provider Demographics
NPI:1285644633
Name:HOWELL, RANDOLPH J (DDS)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:J
Last Name:HOWELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:WOOLWICH
Mailing Address - State:ME
Mailing Address - Zip Code:04579-4520
Mailing Address - Country:US
Mailing Address - Phone:207-443-4962
Mailing Address - Fax:
Practice Address - Street 1:10 EVERETT ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2404
Practice Address - Country:US
Practice Address - Phone:207-729-8939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME31301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice