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General NPI Number Information
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NPI Number | 1568630648
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Entity Type | Organization
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Legal Business Name | NEW IMAGE DENTISTRY, PC
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Dates
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Enumeration Date | 02/12/2008
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Last Update Date | 02/12/2008
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Provider Practice Location Address
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Address Line | 1900 E 15TH ST STE 700A
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City | EDMOND
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State | OK
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Zip | 73013-6692
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Country | US
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Telephone | 405-285-8880
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Fax | 405-285-8881
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Provider Business Mailing Address
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Address Line | 1900 E 15TH ST STE 700A
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City | EDMOND
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State | OK
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Zip | 73013-6692
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Country | US
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Telephone | 405-285-8880
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Fax | 405-285-8881
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MIRIAM NOSRATI
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Credential | DDS
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Telephone | 405-285-8880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5705
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License Number State | OK
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