Healthcare Provider Details

I. General information

NPI: 1205922069
Provider Name (Legal Business Name): BETSY H NEWMAN D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD DENTAL SERVICE W160
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

330 19TH ST
SANTA MONICA CA
90402-2410
US

V. Phone/Fax

Practice location:
  • Phone: 310-268-3776
  • Fax:
Mailing address:
  • Phone: 310-899-1242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number38337
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS025472L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number16222
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: