MEDICARE: MARY RENE NEWTON RDHAP, BS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	287	CA

General Provider Information

NPI Number	:	1720300163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY RENE NEWTON RDHAP, BS

Provider Business Mailing Address
First Line	:	5830 OAK KNOLLS RD
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-4520
Country	:	US
Telephone Number	:	805-582-1677
Fax Number	:	805-306-0917

Provider Business Practice Location Address
First Line	:	5830 OAK KNOLLS RD
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-4520
Country	:	US
Telephone Number	:	805-582-1677
Fax Number	:	805-306-0917

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2010
Last Update Date	:	02/26/2010

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