Provider Demographics
NPI:1972515039
Name:NEWMAN, BRUCE JEFFREY (DDS)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:JEFFREY
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4939 JUNIPERO SERRA BL
Mailing Address - Street 2:
Mailing Address - City:COLMA
Mailing Address - State:CA
Mailing Address - Zip Code:94014-3216
Mailing Address - Country:US
Mailing Address - Phone:650-755-4050
Mailing Address - Fax:650-755-4056
Practice Address - Street 1:4939 JUNIPERO SERRA BL
Practice Address - Street 2:
Practice Address - City:COLMA
Practice Address - State:CA
Practice Address - Zip Code:94014-3216
Practice Address - Country:US
Practice Address - Phone:650-755-4050
Practice Address - Fax:650-755-4056
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27547122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA27547OtherDDS
528451OtherUNITED CONCORDIA
CAB27547-01Medicaid