Casa Grande Impressions II, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D7749 Issued in AZ

Legal business name

CASA GRANDE IMPRESSIONS II, LLC

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

Organization subpart

Yes

Parent organization

IMPRESSIONS DENTAL, PCAs reported in NPPES

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

Authorized official

Name

Dr. Kelly Brandon Wettstein, DMD

Title

Owner

Phone

(480) 814-8888

Specialties & licenses 1

Addresses

Other names 1

• Impressions Dental Doing business as

Part of

Impressions Dental

Locations

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.

• Impressions Dental

  • General Practice Dentistry
  • Chandler, AZ
  • NPI 1033398870
  NPPES parent name

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"
        }
    ]
}

• Casa Grande Emergency Physicians PLLC
• Casa Grande Family Physicians PC
• Casa Grande Family Practice LLC
• Casa Grande Foot & Ankle Spec
• Casa Grande Health Associates Inc
• Casa Grande Internal Medicine PC
• Casa Grande Medical Supplies Inc
• Casa Grande Mobility
• Casa Grande Oral and Maxillofacial Surgery, P.C.
• Casa Grande Pediatric Dentistry

• General Practice Dentistry in Casa Grande, AZ
• Providers in Casa Grande, AZ by specialty
• General Practice Dentistry in Arizona

• 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.