=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861530636
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TITUS A HOWELL DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2510 CHILI AVENUE SUITE 7
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-278-1890
-----------------------------------------------------
Fax | 585-278-1893
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2510 CHILI AVENUE SUITE 7
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-278-1890
-----------------------------------------------------
Fax | 585-278-1893
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | TITUS ANTHONY HOWELL
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 583-278-1890
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 0453601
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------