Provider Demographics
NPI:1497703029
Name:HOWELL, JOHN R JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:HOWELL
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E HILTON ST
Mailing Address - Street 2:
Mailing Address - City:KERSHAW
Mailing Address - State:SC
Mailing Address - Zip Code:29067-1318
Mailing Address - Country:US
Mailing Address - Phone:803-475-6052
Mailing Address - Fax:803-475-4407
Practice Address - Street 1:114 E HILTON ST
Practice Address - Street 2:
Practice Address - City:KERSHAW
Practice Address - State:SC
Practice Address - Zip Code:29067-1318
Practice Address - Country:US
Practice Address - Phone:803-475-6052
Practice Address - Fax:803-475-4407
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD18501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ18507Medicaid