Provider Demographics
NPI:1518161090
Name:LARRY S. HOWELL
Entity Type:Organization
Organization Name:LARRY S. HOWELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-471-1502
Mailing Address - Street 1:PO BOX 71946
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27722-1946
Mailing Address - Country:US
Mailing Address - Phone:919-471-1502
Mailing Address - Fax:919-471-1317
Practice Address - Street 1:5001 OLD FARM RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1407
Practice Address - Country:US
Practice Address - Phone:919-471-1502
Practice Address - Fax:919-471-1317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC37941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8994191Medicaid
NC8994191Medicaid