NPIMap

Organization Active NPI

First Impressions SC

  • Pediatric Dentistry
  • Wausau, WI
National Provider Identifier
1205804663
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
4970 Issued in WI
Legal business name
FIRST IMPRESSIONS SC
Practice address
413 N 17TH Ave
Wausau, WI 54401-2910
Phone
(715) 842-4649
Fax
(715) 842-7331
NPI assigned
Mar 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Carl J Hash, DDS
Title
Owner
Phone
(715) 842-4649

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 5059 WI
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 3444 WI
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 5001555 WI
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 4970 WI Primary

Addresses

Primary practice location

413 N 17TH Ave
Wausau, WI 54401-2910

Mailing address

413 N 17TH Ave
Wausau, WI 54401-2910
Phone (715) 842-4649

Other identifiers 1

IdentifierTypeStateIssuer
38388300MedicaidWI

National Provider Directory

National Provider Directory
Tax ID family
First Impressions Dental East SC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3950 Evergreen Ct
Appleton, WI 54913
Phone (920) 734-4649

2304 Lineville Rd
Ste 101
Green Bay, WI 54313
Phone (715) 298-3983

2633 Development Dr
Ste 40
Green Bay, WI 54311
Phone (715) 298-3983

103 W McMillan St
Marshfield, WI 54449
Phone (715) 298-3983

1660 Oshkosh Ave
Oshkosh, WI 54902

2040 County Road HH
Plover, WI 54467
Phone (715) 298-3983

780 E Timber Dr
Rhinelander, WI 54501
Phone (715) 842-4649

790 Cty Road B
Shawano, WI 54166

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205804663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 N 17TH AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544012910",
            "telephone_number": "715-842-4649",
            "fax_number": "715-842-7331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 N 17TH AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544012910",
            "telephone_number": "715-842-4649",
            "fax_number": "715-842-7331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST IMPRESSIONS SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HASH",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-842-4649",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WI",
            "license": "5059",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WI",
            "license": "3444",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WI",
            "license": "5001555",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WI",
            "license": "4970",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38388300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wausau, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.