| Impressions Dental | |
|
2510 E Independence St Ste 600 Shawnee OK 74804-1839 | |
| (405) 273-2002 | |
| Not Available |
| Full Name | Impressions Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2510 E Independence St Ste 600, Shawnee, Oklahoma |
| Authorized Official Name and Position | Renalla Kaye Ellis (OWNER) |
| Authorized Official Contact | 4052732002 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Impressions Dental 2510 E Independence St Ste 600 Shawnee OK 74804-1839 Ph: (405) 273-2002 | Impressions Dental 2510 E Independence St Ste 600 Shawnee OK 74804-1839 Ph: (405) 273-2002 |
| NPI Number | 1144494147 |
|---|---|
| Provider Enumeration Date | 04/22/2008 |
| Last Update Date | 04/22/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144494147 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5285 (Oklahoma) | Primary |
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