Healthcare Provider Details

I. General information

NPI: 1619074259
Provider Name (Legal Business Name): MARK LEE NEWEY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 03/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

938 S 2000 E STE 100
CLEARFIELD UT
84015-6282
US

IV. Provider business mailing address

3311 COVE CITCLE
LAYTON UT
84040-7487
US

V. Phone/Fax

Practice location:
  • Phone: 801-825-1116
  • Fax:
Mailing address:
  • Phone: 801-698-3569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number280752
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: