Provider Demographics
NPI:1770689713
Name:NEWSOM, DEBORAH FAYE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:FAYE
Last Name:NEWSOM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7751 JANE MARIE CV
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-0424
Mailing Address - Country:US
Mailing Address - Phone:901-387-1215
Mailing Address - Fax:
Practice Address - Street 1:6603 SUMMER KNOLL CV
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2859
Practice Address - Country:US
Practice Address - Phone:901-373-7144
Practice Address - Fax:901-373-4473
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDSOO52461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice