Provider Demographics
NPI:1346946175
Name:NEWPORT FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:NEWPORT FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZWATER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:717-278-4199
Mailing Address - Street 1:91 NEWPORT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:GAP
Mailing Address - State:PA
Mailing Address - Zip Code:17527-9579
Mailing Address - Country:US
Mailing Address - Phone:717-442-8264
Mailing Address - Fax:
Practice Address - Street 1:91 NEWPORT RD STE 101
Practice Address - Street 2:
Practice Address - City:GAP
Practice Address - State:PA
Practice Address - Zip Code:17527-9579
Practice Address - Country:US
Practice Address - Phone:717-442-8264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental