Provider Demographics
NPI:1588106892
Name:HOWE, AMANDA (RDH, RDA)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:HOWE
Suffix:
Gender:F
Credentials:RDH, RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ROSCOMMON
Mailing Address - State:MI
Mailing Address - Zip Code:48653-7658
Mailing Address - Country:US
Mailing Address - Phone:323-275-0725
Mailing Address - Fax:989-275-0729
Practice Address - Street 1:135 LAKE STREET
Practice Address - Street 2:
Practice Address - City:ROSCOMMON
Practice Address - State:MI
Practice Address - Zip Code:48653
Practice Address - Country:US
Practice Address - Phone:989-275-0725
Practice Address - Fax:989-275-0729
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902009035124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist