Provider Demographics
NPI:1497092050
Name:IMAGE DENTISTRY PA
Entity Type:Organization
Organization Name:IMAGE DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBOLEVSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-402-0009
Mailing Address - Street 1:8160 W 135TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-1112
Mailing Address - Country:US
Mailing Address - Phone:913-402-0009
Mailing Address - Fax:913-402-0016
Practice Address - Street 1:8160 W 135TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-1112
Practice Address - Country:US
Practice Address - Phone:913-402-0009
Practice Address - Fax:913-402-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS602001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty