Provider Demographics
NPI:1265164818
Name:NEWMAN, SCOTT (DMD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:NEWMAN
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 1:1161 MALLARD CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-5847
Mailing Address - Country:US
Mailing Address - Phone:502-237-4374
Mailing Address - Fax:
Practice Address - Street 1:1161 MALLARD CREEK RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5847
Practice Address - Country:US
Practice Address - Phone:502-237-4374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10777122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist