Provider Demographics
NPI:1790228674
Name:FIRST IMPRESSIONS SC
Entity Type:Organization
Organization Name:FIRST IMPRESSIONS SC
Other - Org Name:FIRST IMPRESSIONS DENTAL WEST SC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-842-4649
Mailing Address - Street 1:780 E TIMBER DR
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-2004
Mailing Address - Country:US
Mailing Address - Phone:715-842-4649
Mailing Address - Fax:
Practice Address - Street 1:780 E TIMBER DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-2004
Practice Address - Country:US
Practice Address - Phone:715-842-4649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental