Provider Demographics
NPI:1457411076
Name:NEWMAN, HEATHER KAE (DDS)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:KAE
Last Name:NEWMAN
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 1:4350 S NATIONAL
Mailing Address - Street 2:#C112
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810
Mailing Address - Country:US
Mailing Address - Phone:417-885-7040
Mailing Address - Fax:417-885-7041
Practice Address - Street 1:4350 S NATIONAL AVE
Practice Address - Street 2:#C112
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-2607
Practice Address - Country:US
Practice Address - Phone:417-885-7040
Practice Address - Fax:417-885-7041
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOBC76580769122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist