Provider Demographics
NPI:1518915297
Name:NEWLIN, GORDON ERMEL (DDS)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:ERMEL
Last Name:NEWLIN
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:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47220-0206
Mailing Address - Country:US
Mailing Address - Phone:812-358-2333
Mailing Address - Fax:812-358-3631
Practice Address - Street 1:215 W CROSS ST
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47220-1909
Practice Address - Country:US
Practice Address - Phone:812-358-2333
Practice Address - Fax:812-358-3631
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120091951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice