Provider Demographics
NPI:1720188774
Name:NEWMAN, MICHAEL J (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:J
Other - Last Name:NEWMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:103 E NEVADA
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TX
Mailing Address - Zip Code:76380
Mailing Address - Country:US
Mailing Address - Phone:940-889-4444
Mailing Address - Fax:940-889-4450
Practice Address - Street 1:103 E NEVADA
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TX
Practice Address - Zip Code:76380
Practice Address - Country:US
Practice Address - Phone:940-889-4444
Practice Address - Fax:940-889-4450
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB1120701OtherCHIP
TX009529103Medicaid