Provider Demographics
NPI:1215147129
Name:NEWBILL, J. BROOKS (DDS)
Entity type:Individual
Prefix:DR
First Name:J.
Middle Name:BROOKS
Last Name:NEWBILL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 N NEW BALLAS RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6800
Mailing Address - Country:US
Mailing Address - Phone:314-567-4240
Mailing Address - Fax:
Practice Address - Street 1:443 N NEW BALLAS RD
Practice Address - Street 2:SUITE 207
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6800
Practice Address - Country:US
Practice Address - Phone:314-567-4240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO11324122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist