MEDICARE: JOHN G NEWKIRK DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	8819	TX

General Provider Information

NPI Number	:	1720095359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN G NEWKIRK DDS INC

Provider Business Mailing Address
First Line	:	6769 LAKE WOODLANDS DR
Second Line	:	SUITE C
City	:	THE WOODLANDS
State	:	TX
Zip	:	77382-2770
Country	:	US
Telephone Number	:	281-465-8632
Fax Number	:	281-465-8607

Provider Business Practice Location Address
First Line	:	6769 LAKE WOODLANDS DR
Second Line	:	SUITE C
City	:	THE WOODLANDS
State	:	TX
Zip	:	77382-2770
Country	:	US
Telephone Number	:	281-465-8632
Fax Number	:	281-465-8607

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. JOHN G NEWKIRK
Credential	:	DDS
Telephone Number	:	281-465-8632

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	08/22/2020

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