Organization
CASA GRANDE IMPRESSIONS II, LLC
Active
Parent organization
IMPRESSIONS DENTAL, PC
Other names
Impressions Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
IMPRESSIONS DENTAL, PC
Authorized official
DR. KELLY BRANDON WETTSTEIN DMD (OWNER)
(480) 814-8888
Entity
Organization
Contact information
Practice address
442 W KORTSEN RD, SUITE 104, CASA GRANDE, AZ 85222-5913
(520) 374-2400
(520) 374-2500
Mailing address
442 W KORTSEN RD, SUITE 104, CASA GRANDE, AZ 85222-5913
(520) 374-2400
(520) 374-2500
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7749
AZ
Other
Enumeration date
07/22/2009
Last updated
07/22/2009
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