MEDICARE: DR. CLINT EDWIN NEWMAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7887	TN

General Provider Information

NPI Number	:	1104045319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLINT EDWIN NEWMAN D.D.S.

Provider Business Mailing Address
First Line	:	4219 HILLSBORO PIKE
Second Line	:	STE. 104-A
City	:	NASHVILLE
State	:	TN
Zip	:	37215-3328
Country	:	US
Telephone Number	:	615-385-3507
Fax Number	:	615-385-3509

Provider Business Practice Location Address
First Line	:	4219 HILLSBORO PIKE
Second Line	:	STE. 104-A
City	:	NASHVILLE
State	:	TN
Zip	:	37215-3328
Country	:	US
Telephone Number	:	615-385-3507
Fax Number	:	615-385-3509

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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