Individual
AUSTIN MITCHELL NEWSOME
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LD
Contact information
Practice address
215 CURTIS AVE, COOS BAY, OR 97420-1619
(541) 604-6053
Mailing address
215 CURTIS AVE, COOS BAY, OR 97420-1619
(541) 604-6053
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
DN60778096
WA
122400000X
Denturist
Primary
DT-DO-10224514
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DEN-DTR-LIC-23568
STATE OF MONTANA BUSINESS STANDARDS DIVISION
MT
01
—
DN60778096
WASHINGTON DEPARTMENT OF HEALTH
WA
01
—
DT-DO-10224514
OREGON HEALTH LICENSING BOARD OF DENTURE TECHNOLOGY
OR
Enumeration date
05/24/2019
Last updated
08/04/2022
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