Provider Demographics
NPI:1336471044
Name:NEW IMAGE ORTHODONTICS,P.A.
Entity Type:Organization
Organization Name:NEW IMAGE ORTHODONTICS,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-774-9998
Mailing Address - Street 1:8535 W BELLFORT ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-2263
Mailing Address - Country:US
Mailing Address - Phone:713-774-9998
Mailing Address - Fax:
Practice Address - Street 1:8535 W BELLFORT ST
Practice Address - Street 2:SUITE 120
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-2263
Practice Address - Country:US
Practice Address - Phone:713-774-9998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0016426261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental