Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DDS-09073 | IA |
NPI | 1063770808 |
---|---|
Provider Name | Jeffrey Lawrence Howenstein |
First Address | Jefferson, SD 57038-6898 |
Second Address | Dakota Dunes, SD 57049-5099 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2012 |
Last Update Date | 27/05/2014 |