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General NPI Number Information
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NPI Number | 1831502053
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Entity Type | Organization
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Legal Business Name | NEW IMAGE DENTISTRY OF OSCEOLA
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Dates
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Enumeration Date | 06/05/2014
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Last Update Date | 06/05/2014
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Provider Practice Location Address
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Address Line | 3101 13TH ST
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City | SAINT CLOUD
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State | FL
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Zip | 34769-5925
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Country | US
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Telephone | 407-957-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 3101 13TH ST
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City | SAINT CLOUD
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State | FL
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Zip | 34769-5925
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Country | US
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Telephone | 407-957-2000
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | GEORGE SONBOL
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Credential | D.D.S
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Telephone | 407-957-2000
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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 | DN19532
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License Number State | FL
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