Organization
NEW IMAGE FAMILY DENTISTRY M
Active
Other names
NEW IMAGE FAMILY DENTISTRY M
Organization subpart
No
Provider details
NPI number
Authorized official
DIRENDIA SHACKELFORD (MANAGED CARE SPECIALIST)
(800) 654-0889
Entity
Organization
Contact information
Practice address
2713 MOUNT MORIAH RD STE 101, MEMPHIS, TN 38115-1620
(901) 547-1594
(901) 794-2165
Mailing address
2713 MOUNT MORIAH RD STE 101, MEMPHIS, TN 38115-1620
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
DS0000006961
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4438708
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/23/2006
Last updated
08/22/2020
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