Provider Demographics
NPI:1467113175
Name:IMPRESSIVE SMILES TAMPA LLC
Entity Type:Organization
Organization Name:IMPRESSIVE SMILES TAMPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:PHILLIPS
Authorized Official - Last Name:YOPP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-962-8888
Mailing Address - Street 1:310 E HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1727
Mailing Address - Country:US
Mailing Address - Phone:813-484-8658
Mailing Address - Fax:
Practice Address - Street 1:14017 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2401
Practice Address - Country:US
Practice Address - Phone:813-962-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty