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General NPI Number Information
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NPI Number | 1629131446
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Entity Type | Organization
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Legal Business Name | NU IMAGE DENTISTRY
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2076 E SOUTHERN AVE STE C102
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City | TEMPE
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State | AZ
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Zip | 85282-7520
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Country | US
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Telephone | 480-699-5357
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Fax | 480-699-5387
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Provider Business Mailing Address
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Address Line | 2076 E SOUTHERN AVE STE C102
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City | TEMPE
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State | AZ
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Zip | 85282-7520
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Country | US
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Telephone | 480-699-5357
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Fax | 480-699-5387
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Authorized Official
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Title or Position | FRONT OFFICE MANAGER
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Name | STEPHANIE A. LAWTON
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Credential |
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Telephone | 602-326-8888
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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 | AZ 873
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License Number State | AZ
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