Provider Demographics
NPI:1023145430
Name:HOWARD, CHARLES D (DMD)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:D
Last Name:HOWARD
Suffix:
Gender:M
Credentials:DMD
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 297
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MS
Mailing Address - Zip Code:39095-0297
Mailing Address - Country:US
Mailing Address - Phone:662-834-1585
Mailing Address - Fax:662-834-1583
Practice Address - Street 1:102 WALL ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MS
Practice Address - Zip Code:39095
Practice Address - Country:US
Practice Address - Phone:662-834-1585
Practice Address - Fax:662-834-1583
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY45981223G0001X
MS3899161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08338850Medicaid