Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DN23104 | FL |
NPI | 1043753577 |
---|---|
Provider Name | Dr. Bianca Newman |
First Address | Orlando, FL 32814-6849 |
Second Address | Orlando, FL 32832-6991 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2016 |
Last Update Date | 08/07/2019 |