Provider Demographics
NPI:1427052950
Name:NEUWIRTH, BRYAN R (DDS, MD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:R
Last Name:NEUWIRTH
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 18TH STREET CIR SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1362
Mailing Address - Country:US
Mailing Address - Phone:828-327-7867
Mailing Address - Fax:828-327-6299
Practice Address - Street 1:261 18TH STREET CIR SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1362
Practice Address - Country:US
Practice Address - Phone:828-327-7867
Practice Address - Fax:828-327-6299
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC361211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8996361Medicaid
NC2339122OtherMEDICARE GROUP NUMBER
NC2339122OtherMEDICARE GROUP NUMBER
NC8996361Medicaid