Provider Demographics
NPI:1891957239
Name:NEWELL, KENT D (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:D
Last Name:NEWELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 LAKE OTIS PKWY
Mailing Address - Street 2:#210
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5223
Mailing Address - Country:US
Mailing Address - Phone:907-562-2820
Mailing Address - Fax:907-562-6781
Practice Address - Street 1:4050 LAKE OTIS PKWY
Practice Address - Street 2:#210
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5223
Practice Address - Country:US
Practice Address - Phone:907-562-2820
Practice Address - Fax:907-562-6781
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice