Provider Demographics
NPI:1831423623
Name:NEWHART DENTAL INC
Entity type:Organization
Organization Name:NEWHART DENTAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEWHART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-215-0112
Mailing Address - Street 1:20062 SW BIRCH ST STE 220
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1519
Mailing Address - Country:US
Mailing Address - Phone:949-863-9654
Mailing Address - Fax:949-625-7525
Practice Address - Street 1:4520 EXECUTIVE DR STE 340
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3020
Practice Address - Country:US
Practice Address - Phone:858-677-0661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47763122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty