Provider Demographics
NPI:1083870752
Name:DENTAL IMPRESSIONS PC
Entity Type:Organization
Organization Name:DENTAL IMPRESSIONS PC
Other - Org Name:PREMIER FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SWEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-943-5777
Mailing Address - Street 1:3401 WOLFE CIR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-2227
Mailing Address - Country:US
Mailing Address - Phone:214-862-3100
Mailing Address - Fax:
Practice Address - Street 1:909 W SPRING CREEK PKWY
Practice Address - Street 2:SUITE 490
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-4472
Practice Address - Country:US
Practice Address - Phone:972-943-5777
Practice Address - Fax:972-943-5780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty