Provider Demographics
NPI:1861455677
Name:NEIHART, TOM RAY (DDS)
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:RAY
Last Name:NEIHART
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:86 MAIL COACH RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-1006
Mailing Address - Country:US
Mailing Address - Phone:701-239-3700
Mailing Address - Fax:701-239-3729
Practice Address - Street 1:DENTAL SERVICE FARGO VAMC
Practice Address - Street 2:2101 ELM STREET N.
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102
Practice Address - Country:US
Practice Address - Phone:701-239-3700
Practice Address - Fax:701-239-3729
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN41821223P0700X
RIDEN028881223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223P0700XDental ProvidersDentistProsthodontics