Basic Information
| Provider Information | |||||||||
| NPI: | 1861455677 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEIHART | ||||||||
| FirstName: | TOM | ||||||||
| MiddleName: | RAY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 86 MAIL COACH RD | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028711006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012393700 | ||||||||
| FaxNumber: | 7012393729 | ||||||||
| Practice Location | |||||||||
| Address1: | DENTAL SERVICE FARGO VAMC | ||||||||
| Address2: | 2101 ELM STREET N. | ||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 58102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012393700 | ||||||||
| FaxNumber: | 7012393729 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0700X | DEN4182 | DC | X | Dental Providers | Dentist | Prosthodontics | 1223P0700X | DEN02888 | RI | X | Dental Providers | Dentist | Prosthodontics |
No ID Information.