Provider Demographics
NPI:1427372259
Name:IMAGDENT OF MEMPHIS, LLC
Entity Type:Organization
Organization Name:IMAGDENT OF MEMPHIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-758-0330
Mailing Address - Street 1:6800 POPLAR AVE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7450
Mailing Address - Country:US
Mailing Address - Phone:901-758-0330
Mailing Address - Fax:901-758-0322
Practice Address - Street 1:6800 POPLAR AVE
Practice Address - Street 2:SUITE 121
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-7450
Practice Address - Country:US
Practice Address - Phone:901-758-0330
Practice Address - Fax:901-758-0322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1090049482471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed TomographyGroup - Single Specialty