Provider Demographics
NPI:1831502053
Name:NEW IMAGE DENTISTRY OF OSCEOLA
Entity Type:Organization
Organization Name:NEW IMAGE DENTISTRY OF OSCEOLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SONBOL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-957-2000
Mailing Address - Street 1:3101 13TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-5925
Mailing Address - Country:US
Mailing Address - Phone:407-957-2000
Mailing Address - Fax:
Practice Address - Street 1:3101 13TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-5925
Practice Address - Country:US
Practice Address - Phone:407-957-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19532122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty