Provider Demographics
NPI:1447346358
Name:NEWINGHAM, JUSTIN C (DDS)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:C
Last Name:NEWINGHAM
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 1:2425 E. LINCOLN ST. #110
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009
Mailing Address - Country:US
Mailing Address - Phone:248-644-1810
Mailing Address - Fax:248-644-4692
Practice Address - Street 1:2425 E. LINCOLN ST. #110
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009
Practice Address - Country:US
Practice Address - Phone:248-644-1810
Practice Address - Fax:248-644-4692
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010190961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice