Provider Demographics
NPI:1093803736
Name:NEWMAN, DALE ALLEN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:ALLEN
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 N HACKETT AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-3444
Mailing Address - Country:US
Mailing Address - Phone:414-906-9117
Mailing Address - Fax:414-906-9115
Practice Address - Street 1:10950 W FOREST HOME AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-2556
Practice Address - Country:US
Practice Address - Phone:414-427-0288
Practice Address - Fax:414-427-0655
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2940-0151223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU53385Medicare UPIN
WI000077417Medicare ID - Type Unspecified