Provider Demographics
NPI:1528636461
Name:HOWARD, TIMMY (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMMY
Middle Name:
Last Name:HOWARD
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:PO BOX 330382
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BCH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-0382
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11806 ATLANTIC BLVD STE 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-2968
Practice Address - Country:US
Practice Address - Phone:904-999-3386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN26022122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist