Provider Demographics
NPI:1245644970
Name:HOWELL, SCOTT (DMD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:HOWELL
Suffix:
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 1:1701 E THOMAS RD
Mailing Address - Street 2:STE 204
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7646
Mailing Address - Country:US
Mailing Address - Phone:602-253-6600
Mailing Address - Fax:602-733-6480
Practice Address - Street 1:1701 E THOMAS RD
Practice Address - Street 2:STE 204
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7646
Practice Address - Country:US
Practice Address - Phone:602-253-6600
Practice Address - Fax:602-733-6480
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9320122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ052871Medicaid