| NPI | 1053495697 |
|---|---|
| Doing Business As | NEW IMAGE FAMILY DENTISTRY R |
| Entity Type | Organization |
| Authorized Contact | DIRENDIA SHACKELFORD Managed Care Specialist 800-654-0889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: TN DS0000006961) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2020-08-22 |