Healthcare Provider Details

I. General information

NPI: 1619928538
Provider Name (Legal Business Name): PAULETTE MARIE NEWMAN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 N RIVERSIDE AVE
RIALTO CA
92376-8062
US

IV. Provider business mailing address

1733 N RIVERSIDE AVE
RIALTO CA
92376-8062
US

V. Phone/Fax

Practice location:
  • Phone: 909-875-2548
  • Fax: 909-875-3592
Mailing address:
  • Phone: 909-875-2548
  • Fax: 909-875-3592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number43470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: