| NPI | 1568941300 |
|---|---|
| Doing Business As | NEW IMAGE DENTISTRY ST CLOUD-KISSIMMEE |
| Entity Type | Organization |
| Authorized Contact | ANNETTTE MARLOW Credentialing Supervisor 724-698-2119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2018-08-13 |