=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851481238
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAVID O NEWPORT DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2006
-----------------------------------------------------
Last Update Date | 09/14/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2502 PORTLAND RD
-----------------------------------------------------
City | NEWBERG
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97132-1923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-538-4289
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7425 WRIGLEY DR #201
-----------------------------------------------------
City | PASCO
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99301-5292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-543-4948
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 1258
-----------------------------------------------------
License Number State | AK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | D9524
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DE00010688
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------