Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 06144 | IA |
NPI | 1023066560 |
---|---|
Provider Name | Dr. Craig Elliott Newell |
First Address | Spirit Lake, IA 51360-0407 |
Second Address | Spirit Lake, IA 51360-0407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 08/07/2007 |