Provider Demographics
NPI:1689727729
Name:NEWMAN, JOHN GRAHAM (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GRAHAM
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1537 PARK PL STE 300
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-1986
Mailing Address - Country:US
Mailing Address - Phone:920-498-8711
Mailing Address - Fax:920-498-9030
Practice Address - Street 1:1537 PARK PL STE 300
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-1986
Practice Address - Country:US
Practice Address - Phone:920-498-8711
Practice Address - Fax:920-498-9030
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5000810-0151223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics