Organization
IMPRESSIONS DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RENALLA KAYE ELLIS D.D.S. (OWNER)
(405) 273-2002
Entity
Organization
Contact information
Practice address
2510 E INDEPENDENCE ST STE 600, SHAWNEE, OK 74804-1839
(405) 273-2002
Mailing address
2510 E INDEPENDENCE ST STE 600, SHAWNEE, OK 74804-1839
(405) 273-2002
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5285
OK
Other
Enumeration date
04/22/2008
Last updated
04/22/2008
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