Provider Demographics
NPI:1396091799
Name:NEWSOME, BOYD EMMITT (DMD)
Entity type:Individual
Prefix:DR
First Name:BOYD
Middle Name:EMMITT
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 1:4421 IRVING BLVD NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114
Mailing Address - Country:US
Mailing Address - Phone:505-821-6910
Mailing Address - Fax:505-792-5771
Practice Address - Street 1:4421 IRVING BLVD NW
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114
Practice Address - Country:US
Practice Address - Phone:505-821-6910
Practice Address - Fax:505-792-5771
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD4283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist