Provider Demographics
NPI:1689268997
Name:IMAGDENT AUSTIN GROUP LLC
Entity Type:Organization
Organization Name:IMAGDENT AUSTIN GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARUN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-437-3175
Mailing Address - Street 1:7800 N MOPAC EXPY STE 115
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8961
Mailing Address - Country:US
Mailing Address - Phone:512-795-9950
Mailing Address - Fax:512-795-9951
Practice Address - Street 1:7800 N MOPAC EXPY STE 115
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8961
Practice Address - Country:US
Practice Address - Phone:512-795-9950
Practice Address - Fax:512-795-9951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology