Provider Demographics
NPI:1922248384
Name:ONSITE 3D DENTAL IMAGING INC
Entity Type:Organization
Organization Name:ONSITE 3D DENTAL IMAGING INC
Other - Org Name:INNOVATIVE DENTAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:H
Authorized Official - Last Name:BONHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:832-813-8613
Mailing Address - Street 1:1011 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3249
Mailing Address - Country:US
Mailing Address - Phone:832-813-8613
Mailing Address - Fax:866-325-8196
Practice Address - Street 1:1011 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 130
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3249
Practice Address - Country:US
Practice Address - Phone:832-813-8613
Practice Address - Fax:866-325-8196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology