Provider Demographics
NPI:1679747109
Name:JUSTIN C. NEWINGHAM D.D.S.
Entity Type:Organization
Organization Name:JUSTIN C. NEWINGHAM D.D.S.
Other - Org Name:THE BEAUTIFUL SMILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:NEWINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-644-1810
Mailing Address - Street 1:50 W BIG BEAVER RD STE 240
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-3907
Mailing Address - Country:US
Mailing Address - Phone:248-644-1810
Mailing Address - Fax:248-644-4692
Practice Address - Street 1:50 W BIG BEAVER RD STE 240
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-3907
Practice Address - Country:US
Practice Address - Phone:248-644-1810
Practice Address - Fax:248-644-4692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI190961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1689760118OtherNPI
MI1447346358OtherNPI