Provider Demographics
NPI:1225657133
Name:IMPRESSIONS DENTAL OF HARRAH
Entity Type:Organization
Organization Name:IMPRESSIONS DENTAL OF HARRAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KARA
Authorized Official - Middle Name:DEANN
Authorized Official - Last Name:ARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-445-6999
Mailing Address - Street 1:20926 SE 29TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045-6610
Mailing Address - Country:US
Mailing Address - Phone:405-445-6999
Mailing Address - Fax:405-445-7223
Practice Address - Street 1:20926 SE 29TH ST STE A
Practice Address - Street 2:
Practice Address - City:HARRAH
Practice Address - State:OK
Practice Address - Zip Code:73045-6610
Practice Address - Country:US
Practice Address - Phone:405-445-6999
Practice Address - Fax:405-445-7223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental