NPIMap

Organization Active NPI

Casa Grande Impressions II, LLC

Doing business as Impressions Dental

  • General Practice Dentistry
  • Casa Grande, AZ
National Provider Identifier
1851521918
Registry record updated Jul 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D7749 Issued in AZ
Legal business name
CASA GRANDE IMPRESSIONS II, LLC
Doing business as
Impressions Dental
Practice address
442 W Kortsen Rd
Suite 104
Casa Grande, AZ 85222-5913
Phone
(520) 374-2400
Fax
(520) 374-2500
NPI assigned
Jul 22, 2009
Last updated
Jul 22, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
IMPRESSIONS DENTAL, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 22, 2009

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

Authorized official

Name
Dr. Kelly Brandon Wettstein, DMDNPI 1285739078
Title
Owner
Phone
(480) 814-8888

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X D7749 AZ Primary

Addresses

Primary practice location

442 W Kortsen Rd
Suite 104
Casa Grande, AZ 85222-5913

Mailing address

442 W Kortsen Rd
Suite 104
Casa Grande, AZ 85222-5913
Phone (520) 374-2400

Other names 1

  • Impressions Dental Doing business as

National Provider Directory

National Provider Directory
Part of
Impressions Dental

Locations

442 W Kortsen Rd
Ste 104
Casa Grande, AZ 85122
Phone (520) 374-2400

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1248220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248220800000",
    "number": "1851521918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "442 W KORTSEN RD",
            "address_2": "SUITE 104",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "852225913",
            "telephone_number": "520-374-2400",
            "fax_number": "520-374-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "442 W KORTSEN RD",
            "address_2": "SUITE 104",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "852225913",
            "telephone_number": "520-374-2400",
            "fax_number": "520-374-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASA GRANDE IMPRESSIONS II, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IMPRESSIONS DENTAL, PC",
        "enumeration_date": "2009-07-22",
        "last_updated": "2009-07-22",
        "status": "A",
        "authorized_official_last_name": "WETTSTEIN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "BRANDON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-814-8888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D7749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Impressions Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Casa Grande, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2009; 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.