Provider Demographics
NPI:1316543242
Name:IMAGEN CAMBRIDGE, LLC
Entity Type:Organization
Organization Name:IMAGEN CAMBRIDGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:864-934-7131
Mailing Address - Street 1:1302 SC HWY 72 BUSINESS
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649
Mailing Address - Country:US
Mailing Address - Phone:864-229-5885
Mailing Address - Fax:864-229-1002
Practice Address - Street 1:1302 SC HWY 72 BUSINESS
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649
Practice Address - Country:US
Practice Address - Phone:864-229-5885
Practice Address - Fax:864-229-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty