MEDICARE: DR. PATRICIA JEAN NEW 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	1223G0001X	General Practice Dentistry	12010449A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1744673	OTHER	IN	UNITED CONCORDIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851358626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA JEAN NEW D.D.S.

Provider Business Mailing Address
First Line	:	1700 WEST SMITH VALLEY ROAD,
Second Line	:	SUITE C-2
City	:	GREENWOOD
State	:	IN
Zip	:	46142-7106
Country	:	US
Telephone Number	:	317-888-6684
Fax Number	:	317-888-6687

Provider Business Practice Location Address
First Line	:	1700 WEST SMITH VALLEY ROAD,
Second Line	:	SUITE C-2
City	:	GREENWOOD
State	:	IN
Zip	:	46142-7106
Country	:	US
Telephone Number	:	317-888-6684
Fax Number	:	317-888-6687

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	05/27/2014

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