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General NPI Number Information
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NPI Number | 1154746758
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Entity Type | Organization
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Legal Business Name | NEWBERG KIDS DENTIST LLC
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Dates
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Enumeration Date | 02/19/2014
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 2502 E PORTLAND RD
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City | NEWBERG
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State | OR
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Zip | 97132-1923
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Country | US
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Telephone | 503-538-4289
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Fax | 503-538-4352
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Provider Business Mailing Address
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Address Line | 2502 E PORTLAND RD
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City | NEWBERG
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State | OR
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Zip | 97132-1923
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Country | US
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Telephone | 503-538-4289
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Fax | 503-538-4352
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | NAVID NEWPORT
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Credential | DDS
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Telephone | 360-747-2111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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