Provider Demographics
NPI:1821392408
Name:DALE A. NEWMAN S C
Entity Type:Organization
Organization Name:DALE A. NEWMAN S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:414-427-0288
Mailing Address - Street 1:10950 W FOREST HOME AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-2556
Mailing Address - Country:US
Mailing Address - Phone:414-427-0288
Mailing Address - Fax:414-427-0655
Practice Address - Street 1:10950 W FOREST HOME AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-2556
Practice Address - Country:US
Practice Address - Phone:414-427-0288
Practice Address - Fax:414-427-0655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2940-15261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU53385Medicare UPIN