=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083870752
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENTAL IMPRESSIONS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2008
-----------------------------------------------------
Last Update Date | 08/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 909 W SPRING CREEK PKWY SUITE 490
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75023-4472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-943-5777
-----------------------------------------------------
Fax | 972-943-5780
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3401 WOLFE CIR
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75025-2227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-862-3100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. SWEETA WALIA
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 972-943-5777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 22451
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------