Provider Demographics
NPI:1215157615
Name:HOWELL, LAWRENCE W (DDS)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:W
Last Name:HOWELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 J ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-3839
Mailing Address - Country:US
Mailing Address - Phone:812-279-9767
Mailing Address - Fax:812-279-5971
Practice Address - Street 1:1545 J ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3839
Practice Address - Country:US
Practice Address - Phone:812-279-9767
Practice Address - Fax:812-279-5971
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008399A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100278100AMedicaid