Provider Demographics
NPI:1063551901
Name:NEWSOME FAMILY DENTISTRY
Entity type:Organization
Organization Name:NEWSOME FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JARRETT
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:803-782-6966
Mailing Address - Street 1:1701 SAINT JULIAN PL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2418
Mailing Address - Country:US
Mailing Address - Phone:803-254-2465
Mailing Address - Fax:803-254-3008
Practice Address - Street 1:2120 N. BELTLINE BLVD
Practice Address - Street 2:STE A
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-3905
Practice Address - Country:US
Practice Address - Phone:803-782-6966
Practice Address - Fax:803-782-6966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3642122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3642Medicaid