Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 47763 | CA |
NPI | 1003065491 |
---|---|
Provider Name | Dr. Damian Newhart |
First Address | Laguna Niguel, CA 92677-7302 |
Second Address | Laguna Niguel, CA 92677-7302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2008 |
Last Update Date | 10/09/2008 |