Provider Demographics
NPI:1720148190
Name:HOWELL, LARRY SHEPHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:SHEPHARD
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:P.O. BOX 71946
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27722-1946
Mailing Address - Country:US
Mailing Address - Phone:919-471-1502
Mailing Address - Fax:919-471-1317
Practice Address - Street 1:5001 OLD FARM ROAD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1407
Practice Address - Country:US
Practice Address - Phone:919-471-1502
Practice Address - Fax:919-471-1317
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC37941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8994191Medicaid