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General NPI Number Information
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NPI Number | 1407035892
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Entity Type | Organization
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Legal Business Name | NEW IMAGE DENTAL, PLLC
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 540 N 13TH ST
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City | ROGERS
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State | AR
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Zip | 72756-3432
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Country | US
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Telephone | 479-636-4351
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Fax | 479-631-6988
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Provider Business Mailing Address
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Address Line | 540 NORTH 13TH ST.
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City | ROGERS
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State | AR
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Zip | 72756
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Country | US
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Telephone | 479-636-4351
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Fax | 479-631-6988
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. JOHN ANDREW BAXTER
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Credential | DDS, PA
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Telephone | 479-636-4351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3527
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3225
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License Number State | AR
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