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General NPI Number Information
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NPI Number | 1730337270
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Entity Type | Organization
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Legal Business Name | IMAGE ORTHODONTICS PLLC
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Dates
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Enumeration Date | 09/08/2008
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Last Update Date | 10/22/2008
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Provider Practice Location Address
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Address Line | 522B BRANDIES CIR
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City | MURFREESBORO
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State | TN
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Zip | 37128-4872
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Country | US
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Telephone | 615-867-6960
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Fax |
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Provider Business Mailing Address
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Address Line | 522B BRANDIES CIR SUITE 2
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City | MURFREESBORO
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State | TN
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Zip | 37128-4872
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Country | US
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Telephone | 615-867-6960
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Fax |
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Authorized Official
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Title or Position | DR
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Name | DR. JOHN T PHILIPOSE
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Credential | D.M.D
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Telephone | 615-867-6960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 8823
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License Number State | TX
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