Healthcare Provider Details

I. General information

NPI: 1659442309
Provider Name (Legal Business Name): EDWARD ELIAS HOWARD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 VIRGINIA ST E
CHARLESTON WV
25301
US

IV. Provider business mailing address

1321 VIRGINIA ST E SUITE #1
CHARLESTON WV
25301
US

V. Phone/Fax

Practice location:
  • Phone: 304-343-8805
  • Fax: 304-343-8806
Mailing address:
  • Phone: 304-343-8805
  • Fax: 304-343-8806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2099
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: