Provider Demographics
NPI:1578747507
Name:BRYAN R NEUWIRTH DDS MD PC
Entity Type:Organization
Organization Name:BRYAN R NEUWIRTH DDS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-327-7867
Mailing Address - Street 1:261 18TH ST CR SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1362
Mailing Address - Country:US
Mailing Address - Phone:828-327-7867
Mailing Address - Fax:828-327-6299
Practice Address - Street 1:261 18TH ST CR SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1362
Practice Address - Country:US
Practice Address - Phone:828-327-7867
Practice Address - Fax:828-327-6299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC361211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2339122OtherMEDICARE GROUP NUMBER