Provider Demographics
NPI:1285843292
Name:DR. NEWELL EASLEY D.D.S. LTD
Entity type:Organization
Organization Name:DR. NEWELL EASLEY D.D.S. LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:NEWELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:EASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-763-3430
Mailing Address - Street 1:189 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1202
Mailing Address - Country:US
Mailing Address - Phone:262-763-3430
Mailing Address - Fax:262-763-3410
Practice Address - Street 1:189 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1202
Practice Address - Country:US
Practice Address - Phone:262-763-3430
Practice Address - Fax:262-763-3410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI762G122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty