Provider Demographics
NPI:1073870978
Name:NEWHART DENTAL, INC.
Entity Type:Organization
Organization Name:NEWHART DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:GOULD
Authorized Official - Last Name:NEWHART
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-677-9101
Mailing Address - Street 1:7095 BOTTLE BAY RD
Mailing Address - Street 2:
Mailing Address - City:SAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83860-9041
Mailing Address - Country:US
Mailing Address - Phone:208-255-5505
Mailing Address - Fax:
Practice Address - Street 1:3516 W IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-2222
Practice Address - Country:US
Practice Address - Phone:310-677-9101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty