Provider Demographics
NPI:1710223839
Name:GARY NEWELL, DDS, INC.
Entity Type:Organization
Organization Name:GARY NEWELL, DDS, INC.
Other - Org Name:A DIVISION OF ATLANTIC DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKSON
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?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA10798122300000X
VA6412122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty