Provider Demographics
NPI:1770706020
Name:NEWMAN, CYNTHIA SUSAN (RDH)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:SUSAN
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 QUAILS ROOST RD
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-4713
Mailing Address - Country:US
Mailing Address - Phone:360-683-9582
Mailing Address - Fax:360-417-2519
Practice Address - Street 1:223 E 4TH ST
Practice Address - Street 2:SUITE 14
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3015
Practice Address - Country:US
Practice Address - Phone:360-417-2408
Practice Address - Fax:360-417-2519
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH0001331124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADH00001331Medicaid