Healthcare Provider Details

I. General information

NPI: 1710223839
Provider Name (Legal Business Name): GARY NEWELL, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 INDIAN RIVER RD
VIRGINIA BEACH VA
23464-5320
US

IV. Provider business mailing address

5333 INDIAN RIVER RD
VIRGINIA BEACH VA
23464-5320
US

V. Phone/Fax

Practice location:
  • Phone: 757-420-1507
  • Fax: 757-424-7920
Mailing address:
  • Phone: 757-420-1507
  • Fax: 757-424-7920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6412
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10798
License Number StateVA

VIII. Authorized Official

Name: DR. CARRIE CLARKSON
Title or Position: DENTIST
Credential: DDS
Phone: 757-420-1507