Provider Demographics
NPI:1326267881
Name:GARY NEWELL, D.D.S., INC.
Entity Type:Organization
Organization Name:GARY NEWELL, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-420-1507
Mailing Address - Street 1:5333 INDIAN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-5320
Mailing Address - Country:US
Mailing Address - Phone:757-420-1507
Mailing Address - Fax:757-424-7920
Practice Address - Street 1:5333 INDIAN RIVER RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5320
Practice Address - Country:US
Practice Address - Phone:757-420-1507
Practice Address - Fax:757-424-7920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA64121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1356320337Medicare UPIN
VA1659350635Medicare UPIN