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General NPI Number Information
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NPI Number | 1952647208
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Entity Type | Organization
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Legal Business Name | NEW IMAGE DENTISTRY
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Dates
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Enumeration Date | 12/13/2012
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Last Update Date | 06/17/2016
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Provider Practice Location Address
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Address Line | 819 D AVENUE, SUITE 101
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City | NATIONAL CITY
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State | CA
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Zip | 91950-3465
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Country | US
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Telephone | 619-470-2558
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Fax | 619-475-0799
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Provider Business Mailing Address
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Address Line | 819 D AVENUE, SUITE 101
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City | NATIONAL CITY
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State | CA
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Zip | 91950-3465
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Country | US
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Telephone | 619-470-2558
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Fax | 619-475-0799
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROSSANA TABAL ALFONSO
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Credential | D.D.S.
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Telephone | 619-470-2558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 49220
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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