Provider Demographics
NPI:1801825948
Name:NEWHOUSE, RICNEY F (DMD)
Entity Type:Individual
Prefix:
First Name:RICNEY
Middle Name:F
Last Name:NEWHOUSE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 11TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2461
Mailing Address - Country:US
Mailing Address - Phone:360-425-7220
Mailing Address - Fax:360-425-5045
Practice Address - Street 1:855 11TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2461
Practice Address - Country:US
Practice Address - Phone:360-425-7220
Practice Address - Fax:360-425-5045
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000081211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5049473Medicaid