Provider Demographics
NPI:1497074504
Name:NEWBERN, JEFFERSON LAMAR IV (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFERSON
Middle Name:LAMAR
Last Name:NEWBERN
Suffix:IV
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 1:3609 N DIXIE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-5232
Mailing Address - Country:US
Mailing Address - Phone:229-560-5494
Mailing Address - Fax:937-278-8232
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:229-560-5494
Practice Address - Fax:937-278-8232
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8866122300000X
OH30.027009122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist