Provider Demographics
NPI:1891783957
Name:NEWSOM-BROUGHTON, CORY LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:LYNN
Last Name:NEWSOM-BROUGHTON
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 1:4762 GILBERT RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-7301
Mailing Address - Country:US
Mailing Address - Phone:901-396-2797
Mailing Address - Fax:
Practice Address - Street 1:4250 FARONIA RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6527
Practice Address - Country:US
Practice Address - Phone:901-332-8892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8043122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist