Provider Demographics
NPI:1720300163
Name:NEWTON, MARY RENE (RDHAP, BS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:RENE
Last Name:NEWTON
Suffix:
Gender:F
Credentials:RDHAP, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5830 OAK KNOLLS RD
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-4520
Mailing Address - Country:US
Mailing Address - Phone:805-582-1677
Mailing Address - Fax:805-306-0917
Practice Address - Street 1:5830 OAK KNOLLS RD
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-4520
Practice Address - Country:US
Practice Address - Phone:805-582-1677
Practice Address - Fax:805-306-0917
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA287124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist