MEDICARE: MR. WALTER GASH HOWELL D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5604	NC

General Provider Information

NPI Number	:	1255363834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WALTER GASH HOWELL D.D.S.

Provider Business Mailing Address
First Line	:	2721 HORSE PEN CREEK RD
Second Line	:	SUITE 101
City	:	GREENSBORO
State	:	NC
Zip	:	27410-8387
Country	:	US
Telephone Number	:	336-323-2822
Fax Number	:	336-323-2876

Provider Business Practice Location Address
First Line	:	2721 HORSE PEN CREEK RD
Second Line	:	SUITE 101
City	:	GREENSBORO
State	:	NC
Zip	:	27410-8387
Country	:	US
Telephone Number	:	336-323-2822
Fax Number	:	336-323-2876

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/08/2007

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