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General NPI Number Information
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NPI Number | 1063551901
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Entity Type | Organization
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Legal Business Name | NEWSOME FAMILY DENTISTRY
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 11/01/2021
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Provider Practice Location Address
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Address Line | 2120 N. BELTLINE BLVD STE A
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City | COLUMBIA
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State | SC
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Zip | 29204-3905
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Country | US
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Telephone | 803-782-6966
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Fax | 803-782-6966
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Provider Business Mailing Address
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Address Line | 1701 SAINT JULIAN PL SUITE 202
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City | COLUMBIA
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State | SC
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Zip | 29204-2418
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Country | US
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Telephone | 803-254-2465
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Fax | 803-254-3008
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. JARRETT RUSSELL NEWSOME
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Credential | DDS
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Telephone | 803-782-6966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3642
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License Number State | SC
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