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General NPI Number Information
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NPI Number | 1952119174
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Entity Type | Organization
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Legal Business Name | JEFFERSON NEWBERN, DMD, PLLC
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 3609 N DIXIE DR
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City | DAYTON
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State | OH
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Zip | 45414-5232
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Country | US
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Telephone | 937-278-7954
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Fax |
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Provider Business Mailing Address
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Address Line | 1338 S 1ST ST
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City | LOUISVILLE
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State | KY
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Zip | 40208-2302
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Country | US
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Telephone | 229-560-5494
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFERSON LAMAR NEWBERN IV
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Credential | DMD
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Telephone | 229-560-5494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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