Provider Demographics
NPI:1871587188
Name:NEWSOM, TIMOTHY BRYAN (DMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:BRYAN
Last Name:NEWSOM
Suffix:
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 1:2728 FARRAGUT RD
Mailing Address - Street 2:UNIT #94
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-6104
Mailing Address - Country:US
Mailing Address - Phone:619-392-3154
Mailing Address - Fax:
Practice Address - Street 1:2495 MITSCHER WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92145-2102
Practice Address - Country:US
Practice Address - Phone:858-577-1825
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY66611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice