Healthcare Provider Details

I. General information

NPI: 1740283746
Provider Name (Legal Business Name): LISA PETER HOWARD DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 US ROUTE 1 STE D1
SCARBOROUGH ME
04074-7640
US

IV. Provider business mailing address

306 US ROUTE 1 STE D1
SCARBOROUGH ME
04074-7640
US

V. Phone/Fax

Practice location:
  • Phone: 207-885-1005
  • Fax: 207-510-6131
Mailing address:
  • Phone: 207-885-1005
  • Fax: 207-510-6131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3534
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: