MEDICARE: DR. NADIA KIESEL NEWMAN DDS

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	10964686-9921	UT
2	122300000X	Dentist	13101	NC

General Provider Information

NPI Number	:	1215419338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NADIA KIESEL NEWMAN DDS

Provider Business Mailing Address
First Line	:	619 WHITE OAK XING
Second Line	:
City	:	SWANSBORO
State	:	NC
Zip	:	28584-8479
Country	:	US
Telephone Number	:	619-846-2853
Fax Number	:

Provider Business Practice Location Address
First Line	:	1280 WESTERN BLVD UNIT 200
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-7658
Country	:	US
Telephone Number	:	910-388-0223
Fax Number	:

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

Provider Enumeration Date	:	09/05/2018
Last Update Date	:	02/08/2023

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