Healthcare Provider Details

I. General information

NPI: 1407078124
Provider Name (Legal Business Name): MICHAEL EVAN NEWMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 06/07/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13722 S JOG RD STE B
DELRAY BEACH FL
33446-5909
US

IV. Provider business mailing address

126 WINDWARD DR
PALM BEACH GARDENS FL
33418-4010
US

V. Phone/Fax

Practice location:
  • Phone: 561-258-9947
  • Fax:
Mailing address:
  • Phone: 917-653-7270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number048686
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN 15718
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: