Provider Demographics
NPI:1699828681
Name:NEWMAN, WINONA MAE (DMD)
Entity Type:Individual
Prefix:MS
First Name:WINONA
Middle Name:MAE
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 DICK POND ROAD
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-4833
Mailing Address - Country:US
Mailing Address - Phone:843-294-5437
Mailing Address - Fax:843-294-5440
Practice Address - Street 1:3112 DICK POND ROAD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-4833
Practice Address - Country:US
Practice Address - Phone:843-294-5437
Practice Address - Fax:843-294-5440
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3125122300000X
VA0401008654122300000X
GA012326122300000X
SC0476 PD1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3125Medicaid
SCZA929590Medicaid