Provider Demographics
NPI:1568560373
Name:NEWKIRK, NEALY (DDS)
Entity Type:Individual
Prefix:
First Name:NEALY
Middle Name:
Last Name:NEWKIRK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 MESA WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-2361
Mailing Address - Country:US
Mailing Address - Phone:785-843-2636
Mailing Address - Fax:785-838-9577
Practice Address - Street 1:3310 MESA WAY
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-2361
Practice Address - Country:US
Practice Address - Phone:785-843-2636
Practice Address - Fax:785-838-9577
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS603761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice