Provider Demographics
NPI:1154607612
Name:HOWARD, PAYTIE DAVIS (DDS)
Entity type:Individual
Prefix:DR
First Name:PAYTIE
Middle Name:DAVIS
Last Name:HOWARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4370 LAWRENCEVILLE HWY NW # 3441
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-1100
Mailing Address - Country:US
Mailing Address - Phone:770-972-1800
Mailing Address - Fax:
Practice Address - Street 1:3100 FIVE FORKS TRICKUM RD SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-1890
Practice Address - Country:US
Practice Address - Phone:770-356-9757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2021-07-22
Deactivation Date:2017-09-11
Deactivation Code:
Reactivation Date:2021-01-19
Provider Licenses
StateLicense IDTaxonomies
GADN012113122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist