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General NPI Number Information
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NPI Number | 1497234645
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Entity Type | Organization
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Legal Business Name | NEW IMAGE DENTAL
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 08/08/2018
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Provider Practice Location Address
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Address Line | 3885 S DECATUR BLVD STE 1100
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City | LAS VEGAS
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State | NV
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Zip | 89103-5872
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Country | US
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Telephone | 702-838-3311
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Fax |
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Provider Business Mailing Address
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Address Line | 3885 S DECATUR BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89103-5855
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. PUNEET BRAR
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Credential | DMD
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Telephone | 414-446-0272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State | NV
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