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General NPI Number Information
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NPI Number | 1538204524
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Entity Type | Individual
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Provider Name | STACEY NEWTON-BOOKER DDS
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Gender | Female
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | 3614 WINDER HWY STE 2210
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-3011
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Country | US
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Telephone | 770-932-8869
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Fax | 770-932-8870
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Provider Business Mailing Address
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Address Line | 672 PATHVIEW CT
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City | DACULA
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State | GA
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Zip | 30019-7846
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Country | US
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Telephone | 404-985-5650
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Fax | 770-932-8870
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN 012963
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License Number State | GA
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