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General NPI Number Information
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NPI Number | 1699426163
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Entity Type | Individual
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Provider Name | NICHOLAS SAMUEL HOWARD DMD, MBA
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Gender | Male
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Dates
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Enumeration Date | 01/15/2022
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Last Update Date | 01/15/2022
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Provider Practice Location Address
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Address Line | 6825 BURDEN BLVD STE B
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City | PASCO
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State | WA
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Zip | 99301-5633
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Country | US
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Telephone | 256-698-2756
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Fax |
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Provider Business Mailing Address
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Address Line | 262 E VISTA OAKS LN APT 106
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City | DRAPER
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State | UT
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Zip | 84020-5231
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Country | US
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Telephone | 256-698-2756
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE.61263608
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License Number State | WA
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