Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 2940-015 | WI |
NPI | 1093803736 |
---|---|
Provider Name | Dr. Dale Allen Newman |
First Address | Milwaukee, WI 53211-3444 |
Second Address | Hales Corners, WI 53130-2556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 12/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U53385 | (02) | WI |