Provider Demographics
NPI:1285738906
Name:NEWSOME, STEPHEN BRIAN (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BRIAN
Last Name:NEWSOME
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6111 N DAVIS HWY
Mailing Address - Street 2:BLDG C
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6913
Mailing Address - Country:US
Mailing Address - Phone:850-477-9798
Mailing Address - Fax:850-479-1088
Practice Address - Street 1:6111 N DAVIS HWY
Practice Address - Street 2:BLDG C
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6913
Practice Address - Country:US
Practice Address - Phone:850-477-9798
Practice Address - Fax:850-479-1088
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN154591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice