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General NPI Number Information
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NPI Number | 1154484699
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Entity Type | Individual
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Provider Name | MELVIN DALE NEWCOMB DDS
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Gender | Male
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 216 N 5TH AVE
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City | VIRGINIA
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State | MN
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Zip | 55792
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Country | US
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Telephone | 218-749-8908
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Fax |
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Provider Business Mailing Address
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Address Line | 4416 LAKESIDE DR
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City | EVELETH
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State | MN
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Zip | 55734
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Country | US
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Telephone | 218-749-8908
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 |
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License Number State | MN
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