Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 0401006450 | VA |
NPI | 1073504882 |
---|---|
Provider Name | Dr. Clinton Wilbur Howard III |
First Address | Blacksburg, VA 24060-6665 |
Second Address | Blacksburg, VA 24060-6665 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8010285 | (05) | VA |
T95402 | (02) | VA |