Provider Demographics
NPI:1902997083
Name:HOWELL, TARA L (DMD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:L
Last Name:HOWELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8620 CROWN CRESCENT CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-6783
Mailing Address - Country:US
Mailing Address - Phone:704-814-6006
Mailing Address - Fax:704-321-3425
Practice Address - Street 1:8620 CROWN CRESCENT CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-6783
Practice Address - Country:US
Practice Address - Phone:704-814-6006
Practice Address - Fax:704-321-3425
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC79211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7921OtherLICENSE