=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871489534
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MADISEN BROOKE NEWMAN DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2025
-----------------------------------------------------
Last Update Date | 06/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1527 ROUTE 12
-----------------------------------------------------
City | GALES FERRY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06335-1800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-464-7204
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32 MAPLEWOOD ST
-----------------------------------------------------
City | OLD SAYBROOK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06475-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-464-4780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 14415
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------