Provider Demographics
NPI:1487891024
Name:NEWMAN, DAVIONE B (DA)
Entity type:Individual
Prefix:MR
First Name:DAVIONE
Middle Name:B
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 E 126TH ST
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90222-1007
Mailing Address - Country:US
Mailing Address - Phone:310-631-1880
Mailing Address - Fax:
Practice Address - Street 1:21229 HAWTHORNE BLVD STE A
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5501
Practice Address - Country:US
Practice Address - Phone:310-792-5600
Practice Address - Fax:310-792-5628
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01550355126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01550355OtherDENTAL ASSISANT