Provider Demographics
NPI:1629131446
Name:NU IMAGE DENTISTRY
Entity Type:Organization
Organization Name:NU IMAGE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAWTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-326-8888
Mailing Address - Street 1:2076 E SOUTHERN AVE STE C102
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7520
Mailing Address - Country:US
Mailing Address - Phone:480-699-5357
Mailing Address - Fax:480-699-5387
Practice Address - Street 1:2076 E SOUTHERN AVE STE C102
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7520
Practice Address - Country:US
Practice Address - Phone:480-699-5357
Practice Address - Fax:480-699-5387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ 873122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty