Provider Demographics
NPI:1457404741
Name:DENTAL IMPRESSIONS LLC
Entity Type:Organization
Organization Name:DENTAL IMPRESSIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:JILL
Authorized Official - Last Name:FOUST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-965-0230
Mailing Address - Street 1:205 SE ORALABOR RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-9104
Mailing Address - Country:US
Mailing Address - Phone:515-965-0230
Mailing Address - Fax:515-965-2484
Practice Address - Street 1:205 SE ORALABOR RD
Practice Address - Street 2:SUITE E
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-9104
Practice Address - Country:US
Practice Address - Phone:515-965-0230
Practice Address - Fax:515-965-2484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty