Provider Demographics
NPI:1912556804
Name:FIRST IMPRESSIONS DENTAL LAB, LLC
Entity Type:Organization
Organization Name:FIRST IMPRESSIONS DENTAL LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-545-1460
Mailing Address - Street 1:660 N NEELY ST STE 10
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3825
Mailing Address - Country:US
Mailing Address - Phone:480-545-1460
Mailing Address - Fax:480-545-1430
Practice Address - Street 1:660 N NEELY ST STE 10
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3825
Practice Address - Country:US
Practice Address - Phone:480-545-1460
Practice Address - Fax:480-545-1430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory