Provider Demographics
NPI:1437254604
Name:BLACKWELL, HOWARD FRANCES (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:FRANCES
Last Name:BLACKWELL
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 1:6562 BURNSLINE ROAD
Mailing Address - Street 2:
Mailing Address - City:CROSWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48422
Mailing Address - Country:US
Mailing Address - Phone:810-679-2231
Mailing Address - Fax:
Practice Address - Street 1:31315 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-2453
Practice Address - Country:US
Practice Address - Phone:586-293-3434
Practice Address - Fax:586-293-4460
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0934301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice