Healthcare Provider Details

I. General information

NPI: 1194752071
Provider Name (Legal Business Name): MICHAEL G NEWMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UCLA SCHOOL OF DENTISTRY SECTION OF PERIODONTICS
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

11847 GORHAM AVE #406
LOS ANGELES CA
90049-5424
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-5543
  • Fax:
Mailing address:
  • Phone: 310-442-3603
  • Fax: 310-442-4838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number23018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: