Healthcare Provider Details

I. General information

NPI: 1093803736
Provider Name (Legal Business Name): DALE ALLEN NEWMAN D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10950 W FOREST HOME AVE SUITE 201
HALES CORNERS WI
53130-2556
US

IV. Provider business mailing address

3004 N HACKETT AVE
MILWAUKEE WI
53211-3444
US

V. Phone/Fax

Practice location:
  • Phone: 414-427-0288
  • Fax: 414-427-0655
Mailing address:
  • Phone: 414-906-9117
  • Fax: 414-906-9115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2940-015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: