Provider Demographics
NPI:1336298363
Name:NEWELL, GARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:NEWELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:NEWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2217 MOUNT CARMEL AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-4709
Mailing Address - Country:US
Mailing Address - Phone:215-572-7170
Mailing Address - Fax:215-884-3947
Practice Address - Street 1:2217 MOUNT CARMEL AVE
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-4709
Practice Address - Country:US
Practice Address - Phone:215-572-7170
Practice Address - Fax:215-884-3947
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-021261-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice