Provider Demographics
NPI:1851358626
Name:NEW, PATRICIA JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:JEAN
Last Name:NEW
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 1:1700 WEST SMITH VALLEY ROAD,
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-7106
Mailing Address - Country:US
Mailing Address - Phone:317-888-6684
Mailing Address - Fax:317-888-6687
Practice Address - Street 1:1700 WEST SMITH VALLEY ROAD,
Practice Address - Street 2:SUITE C-2
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-7106
Practice Address - Country:US
Practice Address - Phone:317-888-6684
Practice Address - Fax:317-888-6687
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010449A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1744673OtherUNITED CONCORDIA
IN200532750 AMedicaid