Provider Demographics
NPI:1437229739
Name:NEWLIN, SCOTT DAVID (DMD,MS,PC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:DAVID
Last Name:NEWLIN
Suffix:
Gender:M
Credentials:DMD,MS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 MALINMOR DR
Mailing Address - Street 2:
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304-0585
Mailing Address - Country:US
Mailing Address - Phone:636-922-9100
Mailing Address - Fax:
Practice Address - Street 1:303 JUNGERMANN RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-5366
Practice Address - Country:US
Practice Address - Phone:636-928-3552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE0153381223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics