Provider Demographics
NPI:1639540446
Name:HOWARD, ENRIQUE R (DDS)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:R
Last Name:HOWARD
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 1:3524 GALLAGHER DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-3246
Mailing Address - Country:US
Mailing Address - Phone:850-567-9302
Mailing Address - Fax:
Practice Address - Street 1:314 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-2530
Practice Address - Country:US
Practice Address - Phone:850-618-0114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN214081223G0001X
FLPS28642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No183500000XPharmacy Service ProvidersPharmacist