Provider Demographics
NPI:1255407052
Name:NEWBY, RANDY KIRK (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:KIRK
Last Name:NEWBY
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 1:8113 MEADOW PASS CT.
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1646
Mailing Address - Country:US
Mailing Address - Phone:316-721-3949
Mailing Address - Fax:
Practice Address - Street 1:420 E. MAIN
Practice Address - Street 2:BOX 37
Practice Address - City:MOUNT HOPE
Practice Address - State:KS
Practice Address - Zip Code:67108
Practice Address - Country:US
Practice Address - Phone:316-667-2429
Practice Address - Fax:316-667-1150
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5674122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist