MEDICARE: REGINA HOWARD RDH

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	124Q00000X	Dental Hygienist	2014017621	MO

General Provider Information

NPI Number	:	1366988685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA HOWARD RDH

Provider Business Mailing Address
First Line	:	6502 EL CAMPO CT
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-8118
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6903 WATERMAN AVE
Second Line	:
City	:	UNIVERSITY CITY
State	:	MO
Zip	:	63130-4333
Country	:	US
Telephone Number	:	314-276-8090
Fax Number	:

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

Provider Enumeration Date	:	01/10/2017
Last Update Date	:	01/10/2017

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