Healthcare Provider Details

I. General information

NPI: 1861455677
Provider Name (Legal Business Name): TOM RAY NEIHART DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DENTAL SERVICE FARGO VAMC 2101 ELM STREET N.
FARGO ND
58102
US

IV. Provider business mailing address

86 MAIL COACH RD
PORTSMOUTH RI
02871-1006
US

V. Phone/Fax

Practice location:
  • Phone: 701-239-3700
  • Fax: 701-239-3729
Mailing address:
  • Phone: 701-239-3700
  • Fax: 701-239-3729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDEN4182
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDEN02888
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: