Healthcare Provider Details

I. General information

NPI: 1326267881
Provider Name (Legal Business Name): GARY NEWELL, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
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 TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6412
License Number StateVA

VIII. Authorized Official

Name: DR. GARY L. NEWELL
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 757-420-1507