1215234935 NPI number — HOWARD FAMILY DENTAL-DIAMOND CAUSEWAY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215234935 NPI number — HOWARD FAMILY DENTAL-DIAMOND CAUSEWAY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOWARD FAMILY DENTAL-DIAMOND CAUSEWAY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215234935
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 DIAMOND CSWY
Provider Second Line Business Mailing Address:
MARSHPOINT PLAZA, SUIT 8
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31406-7417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-349-4349
Provider Business Mailing Address Fax Number:
912-349-4355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 DIAMOND CSWY
Provider Second Line Business Practice Location Address:
MARSHPOINT PLAZA, SUIT 8
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31406-7417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-349-4349
Provider Business Practice Location Address Fax Number:
912-349-4355
Provider Enumeration Date:
02/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HOWARD
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
912-629-9001

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DN013299 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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