Provider Demographics
NPI:1528132008
Name:NEWKIRK, DAVID R (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:NEWKIRK
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 1:1816 BAY SCOTT CIR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-1112
Mailing Address - Country:US
Mailing Address - Phone:630-717-9499
Mailing Address - Fax:630-717-9109
Practice Address - Street 1:1816 BAY SCOTT CIR
Practice Address - Street 2:SUITE 108
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1112
Practice Address - Country:US
Practice Address - Phone:630-717-9499
Practice Address - Fax:630-717-9109
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190232811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363918719Medicare UPIN