Healthcare Provider Details

I. General information

NPI: 1245562255
Provider Name (Legal Business Name): ROBERT BRUCE HOWELL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 W 800 N
OREM UT
84057-3728
US

IV. Provider business mailing address

1251 N MURDOCK DR
PLEASANT GROVE UT
84062-8956
US

V. Phone/Fax

Practice location:
  • Phone: 801-802-7200
  • Fax: 802-225-3162
Mailing address:
  • Phone: 801-802-7200
  • Fax: 801-225-3162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number851427559922
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1992716104
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: