Provider Demographics
NPI:1215234935
Name:HOWARD FAMILY DENTAL-DIAMOND CAUSEWAY, LLC
Entity type:Organization
Organization Name:HOWARD FAMILY DENTAL-DIAMOND CAUSEWAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:912-629-9001
Mailing Address - Street 1:1 DIAMOND CSWY
Mailing Address - Street 2:MARSHPOINT PLAZA, SUIT 8
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-7417
Mailing Address - Country:US
Mailing Address - Phone:912-349-4349
Mailing Address - Fax:912-349-4355
Practice Address - Street 1:1 DIAMOND CSWY
Practice Address - Street 2:MARSHPOINT PLAZA, SUIT 8
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-7417
Practice Address - Country:US
Practice Address - Phone:912-349-4349
Practice Address - Fax:912-349-4355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0132991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty