Provider Demographics
NPI:1952119174
Name:JEFFERSON NEWBERN, DMD, PLLC
Entity type:Organization
Organization Name:JEFFERSON NEWBERN, DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERSON
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:NEWBERN
Authorized Official - Suffix:IV
Authorized Official - Credentials:DMD
Authorized Official - Phone:229-560-5494
Mailing Address - Street 1:1338 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-2302
Mailing Address - Country:US
Mailing Address - Phone:229-560-5494
Mailing Address - Fax:
Practice Address - Street 1:3609 N DIXIE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-5232
Practice Address - Country:US
Practice Address - Phone:937-278-7954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental