=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588721344
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANNA E. NEWMAN, D.M.D., PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2007
-----------------------------------------------------
Last Update Date | 06/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 436 MAIN ST
-----------------------------------------------------
City | PARIS
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40361-1813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-987-5550
-----------------------------------------------------
Fax | 859-987-2465
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 436 MAIN ST
-----------------------------------------------------
City | PARIS
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40361-1813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-987-5550
-----------------------------------------------------
Fax | 859-987-2465
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACCOUNTS MANAGER
-----------------------------------------------------
Name | MS. MARYBETH BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 859-987-5550
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 6485
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------