Provider Demographics
NPI:1568630648
Name:NEW IMAGE DENTISTRY, PC
Entity Type:Organization
Organization Name:NEW IMAGE DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NOSRATI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-285-8880
Mailing Address - Street 1:1900 E 15TH ST STE 700A
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6692
Mailing Address - Country:US
Mailing Address - Phone:405-285-8880
Mailing Address - Fax:405-285-8881
Practice Address - Street 1:1900 E 15TH ST STE 700A
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6692
Practice Address - Country:US
Practice Address - Phone:405-285-8880
Practice Address - Fax:405-285-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5705122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty