Provider Demographics
NPI:1952588741
Name:HOWELL DENTAL CENTER
Entity Type:Organization
Organization Name:HOWELL DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELLOGG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-546-3330
Mailing Address - Street 1:1250 BYRON RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-1007
Mailing Address - Country:US
Mailing Address - Phone:517-546-3330
Mailing Address - Fax:517-548-0192
Practice Address - Street 1:1250 BYRON RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1007
Practice Address - Country:US
Practice Address - Phone:517-546-3330
Practice Address - Fax:517-548-0192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13543302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization