Healthcare Provider Details

I. General information

NPI: 1417837477
Provider Name (Legal Business Name): IMPRESS DENTAL WALTHAM P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WINTER ST STE 203
WALTHAM MA
02451-0960
US

IV. Provider business mailing address

396 NORTH RD
BEDFORD MA
01730-1016
US

V. Phone/Fax

Practice location:
  • Phone: 617-390-5371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EUNG JUN IM
Title or Position: PRESIDENT
Credential: PHD, DMD
Phone: 857-231-0200