NPIMap

Organization Active NPI

New Image Family Dentistry R

  • Non-Pharmacy Dispensing Site
  • Memphis, TN
National Provider Identifier
1053495697
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
DS0000006961 Issued in TN
Legal business name
NEW IMAGE FAMILY DENTISTRY R
Practice address
3719 Riverdale Rd
Memphis, TN 38115-5322
Phone
(901) 365-2000
Fax
(901) 365-2626
NPI assigned
Oct 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Direndia Shackelford
Title
Managed Care Specialist
Phone
(800) 654-0889

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X DS0000006961 TN Primary

Addresses

Primary practice location

3719 Riverdale Rd
Memphis, TN 38115-5322

Mailing address

3719 Riverdale Rd
Memphis, TN 38115-5322

Other identifiers 1

IdentifierTypeStateIssuer
4438784OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • NEW IMAGE FAMILY DENTISTRY R Doing business as

National Provider Directory

National Provider Directory
Tax ID family
New Image Family Dentistry M2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053495697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3719 RIVERDALE RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381155322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3719 RIVERDALE RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381155322",
            "telephone_number": "901-365-2000",
            "fax_number": "901-365-2626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW IMAGE FAMILY DENTISTRY R",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHACKELFORD",
        "authorized_official_first_name": "DIRENDIA",
        "authorized_official_title_or_position": "MANAGED CARE SPECIALIST",
        "authorized_official_telephone_number": "800-654-0889"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "TN",
            "license": "DS0000006961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "4438784",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NEW IMAGE FAMILY DENTISTRY R",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.