Provider Demographics
NPI:1497123939
Name:IMAGIX DENTAL OF ALPHARETTA LLC
Entity Type:Organization
Organization Name:IMAGIX DENTAL OF ALPHARETTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP INSURANCE PLAN MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-726-1611
Mailing Address - Street 1:11125 JONES BRIDGE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-0002
Mailing Address - Country:US
Mailing Address - Phone:770-569-0529
Mailing Address - Fax:770-569-0377
Practice Address - Street 1:11125 JONES BRIDGE RD STE 200
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-0002
Practice Address - Country:US
Practice Address - Phone:770-569-0529
Practice Address - Fax:770-569-0377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty