Provider Demographics
NPI:1982298295
Name:IMAGDENT LLC
Entity Type:Organization
Organization Name:IMAGDENT 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 1:12223 W GILES RD
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-5801
Mailing Address - Country:US
Mailing Address - Phone:531-867-4273
Mailing Address - Fax:402-665-1455
Practice Address - Street 1:12223 W GILES RD
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-5801
Practice Address - Country:US
Practice Address - Phone:531-867-4273
Practice Address - Fax:402-665-1455
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