Provider Demographics
NPI:1730161118
Name:NEWSOME, CHANTAL (DDS)
Entity type:Individual
Prefix:DR
First Name:CHANTAL
Middle Name:
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E MAIN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5906
Mailing Address - Country:US
Mailing Address - Phone:410-392-8799
Mailing Address - Fax:
Practice Address - Street 1:109 E MAIN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5906
Practice Address - Country:US
Practice Address - Phone:410-392-8799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD097641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice