Provider Demographics
NPI:1710270004
Name:NEWHOUSE, CHARLA (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLA
Middle Name:
Last Name:NEWHOUSE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2832 ELDORADO PKWY
Mailing Address - Street 2:210
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-7439
Mailing Address - Country:US
Mailing Address - Phone:214-618-5311
Mailing Address - Fax:
Practice Address - Street 1:2832 ELDORADO PKWY
Practice Address - Street 2:210
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-7439
Practice Address - Country:US
Practice Address - Phone:214-618-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX264781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice