Provider Demographics
NPI:1396776753
Name:NEWSOME, CURTIS WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:WAYNE
Last Name:NEWSOME
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4845 JOHNSTON-OEHLER RD., #100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269
Mailing Address - Country:US
Mailing Address - Phone:704-875-8033
Mailing Address - Fax:704-875-8066
Practice Address - Street 1:4845 JOHNSTON-OEHLER RD., #100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-1065
Practice Address - Country:US
Practice Address - Phone:704-875-8033
Practice Address - Fax:704-875-8066
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC56731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8996386Medicaid