Provider Demographics
NPI:1801800461
Name:NEWMAN, GREGORY JON (DMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JON
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N BROAD STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446
Mailing Address - Country:US
Mailing Address - Phone:215-855-1173
Mailing Address - Fax:215-855-1936
Practice Address - Street 1:2100 N BROAD STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446
Practice Address - Country:US
Practice Address - Phone:215-855-1173
Practice Address - Fax:215-855-1936
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029004L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
054393OtherAMERIHEALTH
054393OtherBLUE SHIELD
6440OtherAMERICAN ASSOC. OF ENDODO
89839OtherAETNA
DS029004LOtherSTATE LICENSE
1560OtherAETNA DMO
50012OtherPA DENTAL ASSOCIATION
113237OtherCIGNA
113237OtherCIGNA