MEDICARE: MS. WINONA MAE NEWMAN DMD

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	3125	SC
2	122300000X	Dentist	0401008654	VA
3	122300000X	Dentist	012326	GA
4	1223P0221X	Pediatric Dentistry	0476 PD	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699828681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. WINONA MAE NEWMAN DMD

Provider Business Mailing Address
First Line	:	3112 DICK POND ROAD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-4833
Country	:	US
Telephone Number	:	843-294-5437
Fax Number	:	843-294-5440

Provider Business Practice Location Address
First Line	:	3112 DICK POND ROAD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-4833
Country	:	US
Telephone Number	:	843-294-5437
Fax Number	:	843-294-5440

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

Provider Enumeration Date	:	01/21/2007
Last Update Date	:	03/03/2010

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Directions to “ MS. WINONA MAE NEWMAN DMD” Practice Location

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