Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 25460 | TX |
Y | 204E00000X | Oral & Maxillofacial Surgeon | R0626 | TX |
NPI | 1194032284 |
---|---|
Provider Name | Dr. Phillip R Newton |
First Address | Dallas, TX 75246 |
Second Address | Dallas, TX 75246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2010 |
Last Update Date | 01/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25460 | DENTAL LICENSE (01) | TX |