Healthcare Provider Details

I. General information

NPI: 1699828681
Provider Name (Legal Business Name): WINONA MAE NEWMAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2007
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3112 DICK POND ROAD
MYRTLE BEACH SC
29588-4833
US

IV. Provider business mailing address

3112 DICK POND ROAD
MYRTLE BEACH SC
29588-4833
US

V. Phone/Fax

Practice location:
  • Phone: 843-294-5437
  • Fax: 843-294-5440
Mailing address:
  • Phone: 843-294-5437
  • Fax: 843-294-5440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3125
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401008654
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number012326
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0476 PD
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: