| Organization Name: | IMAGE ORTHODONTICS PC |
| NPI Number: | 1063768471 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RYAN BRADLEY HELMS (PRESIDENT) |
| Mailing Address: | 1748 Northwestern Ave West Lafayette |
| State: | IN US |
| Postal Code: | 479062271 |
| Phone Number: | 7654636622 |
| Fax Number: | |
| NPI Enumeration Date: | 08/03/2012 |
| NPI Last Update Date: | 08/03/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 54001743A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |