Provider Demographics
NPI:1619074259
Name:NEWEY, MARK LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEE
Last Name:NEWEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 COVE CITCLE
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-7487
Mailing Address - Country:US
Mailing Address - Phone:801-698-3569
Mailing Address - Fax:
Practice Address - Street 1:938 S 2000 E STE 100
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-6282
Practice Address - Country:US
Practice Address - Phone:801-825-1116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2807521223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery