Provider Demographics
NPI:1295800506
Name:HOWARD, JOHNATHAN T (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHNATHAN
Middle Name:T
Last Name:HOWARD
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 1:4350 FASHION SQUARE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-1249
Mailing Address - Country:US
Mailing Address - Phone:989-799-7128
Mailing Address - Fax:989-799-3895
Practice Address - Street 1:4350 FASHION SQUARE BOULEVARD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-1249
Practice Address - Country:US
Practice Address - Phone:989-799-7128
Practice Address - Fax:989-799-3895
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010174011223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G36100OtherBCBS
MI0994258OtherHEALTH PLUS
MI0994258OtherHEALTH PLUS
U19368Medicare UPIN