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General NPI Number Information
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NPI Number | 1811204902
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Entity Type | Individual
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Provider Name | ELISE MICHELLE NEWSOME D.D.S
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Gender | Female
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Dates
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Enumeration Date | 09/10/2010
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Last Update Date | 06/07/2012
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Provider Practice Location Address
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Address Line | 104 W. NORTHWOOD STREET SUITE C
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City | GREENSBORO
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State | NC
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Zip | 27401
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Country | US
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Telephone | 919-484-8088
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Fax | 919-484-8044
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Provider Business Mailing Address
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Address Line | 1221 NORTHCREEK DR
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City | DURHAM
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State | NC
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Zip | 27707-3369
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Country | US
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Telephone | 919-308-8018
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9201
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License Number State | NC
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