Organization
NEW IMAGEORTHODONTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAUL GOMEZ (COO)
(623) 825-9445
Entity
Organization
Contact information
Practice address
17235 N 75TH AVE STE A100, GLENDALE, AZ 85308-0884
(623) 825-9445
(623) 825-9446
Mailing address
17235 N 75TH AVE STE A100, GLENDALE, AZ 85308-0884
(623) 825-9445
(623) 825-9446
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
02/05/2019
Last updated
02/05/2019
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