Provider Demographics
NPI:1831522457
Name:IMAGDENT ABILENE, LP
Entity type:Organization
Organization Name:IMAGDENT ABILENE, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-404-1215
Mailing Address - Street 1:14329 SAN PEDRO AVE
Mailing Address - Street 2:STE. C
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4388
Mailing Address - Country:US
Mailing Address - Phone:210-404-1215
Mailing Address - Fax:
Practice Address - Street 1:4400 BUFFALO GAP RD
Practice Address - Street 2:STE. 0475
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-2723
Practice Address - Country:US
Practice Address - Phone:325-232-8692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory