Healthcare Provider Details

I. General information

NPI: 1225657133
Provider Name (Legal Business Name): IMPRESSIONS DENTAL OF HARRAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20926 SE 29TH ST STE A
HARRAH OK
73045-6610
US

IV. Provider business mailing address

20926 SE 29TH ST STE A
HARRAH OK
73045-6610
US

V. Phone/Fax

Practice location:
  • Phone: 405-445-6999
  • Fax: 405-445-7223
Mailing address:
  • Phone: 405-445-6999
  • Fax: 405-445-7223

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: MS. KARA DEANN ARNETT
Title or Position: OFFICE MANAGER
Credential:
Phone: 405-445-6999