Provider Demographics
NPI:1538420195
Name:NEWBY, BRENT FREDRICK (DDS)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:FREDRICK
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 1:2572 SUN SEEKER CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2981
Mailing Address - Country:US
Mailing Address - Phone:859-388-4591
Mailing Address - Fax:
Practice Address - Street 1:2572 SUN SEEKER CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2981
Practice Address - Country:US
Practice Address - Phone:859-388-4591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY91771223S0112X
OH30-024342122300000X
KY9177-D122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery