Provider Demographics
NPI:1841388154
Name:HOWARD, DWIGHT DEE (DDS)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:DEE
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 1:4273 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE 120 EAST
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6748
Mailing Address - Country:US
Mailing Address - Phone:505-883-3229
Mailing Address - Fax:505-881-6557
Practice Address - Street 1:4273 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE 120 EAST
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6748
Practice Address - Country:US
Practice Address - Phone:505-883-3229
Practice Address - Fax:505-881-6557
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM10931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
857760OtherUNITED CONCORDIA