Provider Demographics
NPI:1750421517
Name:HOWELL, JASON RONALD (DMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:RONALD
Last Name:HOWELL
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 1:503 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2046
Mailing Address - Country:US
Mailing Address - Phone:502-254-3913
Mailing Address - Fax:
Practice Address - Street 1:3564 WILLOW WAY
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-8984
Practice Address - Country:US
Practice Address - Phone:502-955-1606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8083122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist