Healthcare Provider Details

I. General information

NPI: 1689223265
Provider Name (Legal Business Name): DRS NEWMAN TAM AND ASSOC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 03/16/2021
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2236 GENERAL BOOTH BLVD STE 100
VIRGINIA BEACH VA
23456-4092
US

IV. Provider business mailing address

2236 GENERAL BOOTH BLVD STE 100
VIRGINIA BEACH VA
23456-4092
US

V. Phone/Fax

Practice location:
  • Phone: 757-427-9300
  • Fax:
Mailing address:
  • Phone: 757-427-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: AMY TAM
Title or Position: DENTIST
Credential: DDS
Phone: 757-427-9300