Organization
NEW IMAGE FAMILY DENTISTRY R
Active
Other names
NEW IMAGE FAMILY DENTISTRY R
Organization subpart
No
Provider details
NPI number
Authorized official
DIRENDIA SHACKELFORD (MANAGED CARE SPECIALIST)
(800) 654-0889
Entity
Organization
Contact information
Practice address
3719 RIVERDALE RD, MEMPHIS, TN 38115-5322
(901) 365-2000
(901) 365-2626
Mailing address
3719 RIVERDALE RD, MEMPHIS, TN 38115-5322
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
DS0000006961
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4438784
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/24/2006
Last updated
08/22/2020
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