MEDICARE: DR. MARK D NEWMAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1630	VA

General Provider Information

NPI Number	:	1922194299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK D NEWMAN D.D.S.

Provider Business Mailing Address
First Line	:	5460 BROCKIE ST
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-7737
Country	:	US
Telephone Number	:	757-965-5194
Fax Number	:

Provider Business Practice Location Address
First Line	:	6000 KANAKANAK RD
Second Line	:
City	:	DILLINGHAM
State	:	AK
Zip	:	99576-0130
Country	:	US
Telephone Number	:	907-842-5201
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	05/19/2021

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