MEDICARE: DR. JOEL NEWTON 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	1223P0300X	Periodontics	D2048	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	60400	OTHER	ID	BLUE CROSS/IDAHO

General Provider Information

NPI Number	:	1497835599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL NEWTON DDS

Provider Business Mailing Address
First Line	:	2064 WASHINGTON STREET NORTH
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301
Country	:	US
Telephone Number	:	208-734-1515
Fax Number	:

Provider Business Practice Location Address
First Line	:	2064 WASHINGTON STREET NORTH
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301
Country	:	US
Telephone Number	:	208-734-1515
Fax Number	:

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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