Provider Demographics
NPI:1902878531
Name:HOWELL, JASON M (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:M
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 1:8302 DRAVO CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-5814
Mailing Address - Country:US
Mailing Address - Phone:502-235-9575
Mailing Address - Fax:502-894-0342
Practice Address - Street 1:10640 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-4350
Practice Address - Country:US
Practice Address - Phone:502-933-4427
Practice Address - Fax:502-935-6538
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7979122300000X, 1223D0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100254720Medicaid