Provider Demographics
NPI:1992716104
Name:R. BRUCE HOWELL D.D.S., M.S.
Entity type:Organization
Organization Name:R. BRUCE HOWELL D.D.S., M.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMISTATIVE ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-895-6611
Mailing Address - Street 1:1251 N MURDOCK DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-8956
Mailing Address - Country:US
Mailing Address - Phone:801-785-5705
Mailing Address - Fax:
Practice Address - Street 1:1251 N MURDOCK DR
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-8956
Practice Address - Country:US
Practice Address - Phone:801-785-5705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT142755-99221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========Medicaid