Provider Demographics
NPI:1518113612
Name:IMAGDENT DFW LLP
Entity Type:Organization
Organization Name:IMAGDENT DFW LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-750-0900
Mailing Address - Street 1:8222 DOUGLAS AVE
Mailing Address - Street 2:SUITE 675
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5923
Mailing Address - Country:US
Mailing Address - Phone:214-750-0900
Mailing Address - Fax:
Practice Address - Street 1:8222 DOUGLAS AVE
Practice Address - Street 2:SUITE 675
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5923
Practice Address - Country:US
Practice Address - Phone:214-750-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed TomographyGroup - Single Specialty