Provider Demographics
NPI:1538204524
Name:NEWTON-BOOKER, STACEY (DDS)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:NEWTON-BOOKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:NEWTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:672 PATHVIEW CT
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7846
Mailing Address - Country:US
Mailing Address - Phone:404-985-5650
Mailing Address - Fax:770-932-8870
Practice Address - Street 1:3614 WINDER HWY STE 2210
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-3011
Practice Address - Country:US
Practice Address - Phone:770-932-8869
Practice Address - Fax:770-932-8870
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN 0129631223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA813355373Medicaid