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General NPI Number Information
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NPI Number | 1497931109
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Entity Type | Organization
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Legal Business Name | ESTHETIC IMAGE DENTISTRY
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Dates
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Enumeration Date | 01/11/2008
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 4708 W PLANO PKWY STE 100
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City | PLANO
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State | TX
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Zip | 75093-5334
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Country | US
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Telephone | 972-612-8388
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Fax | 972-612-4018
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Provider Business Mailing Address
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Address Line | 4708 W PLANO PKWY STE 100
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City | PLANO
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State | TX
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Zip | 75093-5334
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Country | US
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Telephone | 972-612-8388
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Fax | 972-612-4018
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Authorized Official
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Title or Position | OWNER
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Name | JOJO CHEUNG
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Credential | DDS
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Telephone | 972-612-8388
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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 | 16956
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License Number State | TX
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