Provider Demographics
NPI:1215114574
Name:LASTING IMPRESSION DENTAL GROUP,PLLC
Entity type:Organization
Organization Name:LASTING IMPRESSION DENTAL GROUP,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-528-0040
Mailing Address - Street 1:4418 ALMEDA RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-4902
Mailing Address - Country:US
Mailing Address - Phone:713-528-0040
Mailing Address - Fax:713-528-3708
Practice Address - Street 1:4418 ALMEDA RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-4902
Practice Address - Country:US
Practice Address - Phone:713-528-0040
Practice Address - Fax:713-528-3708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty