Healthcare Provider Details

I. General information

NPI: 1265164818
Provider Name (Legal Business Name): SCOTT NEWMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 08/22/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27283 W WARREN ST
DEARBORN HEIGHTS MI
48127-1804
US

IV. Provider business mailing address

2195 E BIG BEAVER RD APT 202
TROY MI
48083-2379
US

V. Phone/Fax

Practice location:
  • Phone: 313-380-6323
  • Fax:
Mailing address:
  • Phone: 385-210-5264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10777
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2901602693
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: