Provider Demographics
NPI:1215757950
Name:IMPRESSIONS DENTISTRY INC
Entity type:Organization
Organization Name:IMPRESSIONS DENTISTRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:OM
Authorized Official - Phone:561-655-8066
Mailing Address - Street 1:1515 N FLAGLER DR STE 520
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3430
Mailing Address - Country:US
Mailing Address - Phone:561-655-8066
Mailing Address - Fax:
Practice Address - Street 1:1515 N FLAGLER DR STE 520
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3430
Practice Address - Country:US
Practice Address - Phone:561-655-8066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental