Provider Demographics
NPI:1104045319
Name:NEWMAN, CLINT EDWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLINT
Middle Name:EDWIN
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4219 HILLSBORO PIKE
Mailing Address - Street 2:STE. 104-A
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-3328
Mailing Address - Country:US
Mailing Address - Phone:615-385-3507
Mailing Address - Fax:615-385-3509
Practice Address - Street 1:4219 HILLSBORO PIKE
Practice Address - Street 2:STE. 104-A
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-3328
Practice Address - Country:US
Practice Address - Phone:615-385-3507
Practice Address - Fax:615-385-3509
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7887122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist