Provider Demographics
NPI:1710993746
Name:NEUWIRTH, S. EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:S.
Middle Name:EDWARD
Last Name:NEUWIRTH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 E HALLANDALE BEACH BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-3771
Mailing Address - Country:US
Mailing Address - Phone:954-456-5611
Mailing Address - Fax:965-458-7130
Practice Address - Street 1:2100 E HALLANDALE BEACH BLVD STE 303
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3771
Practice Address - Country:US
Practice Address - Phone:954-456-5611
Practice Address - Fax:965-458-7130
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL38141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice