Provider Demographics
NPI:1992977631
Name:NEWBERN, JEFFERSON LAMAR III (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFERSON
Middle Name:LAMAR
Last Name:NEWBERN
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:800 NORTHWOOD PARK DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1392
Mailing Address - Country:US
Mailing Address - Phone:229-242-6202
Mailing Address - Fax:229-245-0155
Practice Address - Street 1:800 NORTHWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1392
Practice Address - Country:US
Practice Address - Phone:229-242-6202
Practice Address - Fax:229-245-0155
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA94591223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry