Provider Demographics
NPI:1376789743
Name:NEWMAN, GARY M (DMD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:M
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9325 GLADES RD
Mailing Address - Street 2:STE 103
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3988
Mailing Address - Country:US
Mailing Address - Phone:561-852-8581
Mailing Address - Fax:561-852-8583
Practice Address - Street 1:9325 GLADES RD
Practice Address - Street 2:STE 103
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3988
Practice Address - Country:US
Practice Address - Phone:561-852-8581
Practice Address - Fax:561-852-8583
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7179122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist