Provider Demographics
NPI:1487754982
Name:SHORT, HOWARD B (DMD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:B
Last Name:SHORT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:HOWARD
Other - Middle Name:B
Other - Last Name:SHORT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:5739 CONSTITUTION AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-1220
Mailing Address - Country:US
Mailing Address - Phone:719-574-7631
Mailing Address - Fax:719-574-1290
Practice Address - Street 1:5739 CONSTITUTION AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-1220
Practice Address - Country:US
Practice Address - Phone:719-574-7631
Practice Address - Fax:719-574-1290
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106012122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist