0001819319-20-000008.txt : 20201211 0001819319-20-000008.hdr.sgml : 20201211 20201211152309 ACCESSION NUMBER: 0001819319-20-000008 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20201211 DATE AS OF CHANGE: 20201211 EFFECTIVENESS DATE: 20201211 FILER: COMPANY DATA: COMPANY CONFORMED NAME: IMAGEN DENTAL PARTNERS, LLC CENTRAL INDEX KEY: 0001819319 IRS NUMBER: 845189859 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-383004 FILM NUMBER: 201383458 BUSINESS ADDRESS: STREET 1: 6320 EAST THOMAS ROAD, SUITE 100 CITY: SCOTTSDALE STATE: AZ ZIP: 85251 BUSINESS PHONE: 480-590-5701 MAIL ADDRESS: STREET 1: 6320 EAST THOMAS ROAD, SUITE 100 CITY: SCOTTSDALE STATE: AZ ZIP: 85251 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Imagen Distinctive Dental Support Services, LLC CENTRAL INDEX KEY: 0001834113 IRS NUMBER: 853913268 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-383004-01 FILM NUMBER: 201383457 BUSINESS ADDRESS: STREET 1: 6320 EAST THOMAS ROAD STREET 2: SUITE 100 CITY: SCOTTSDALE STATE: AZ ZIP: 85251 BUSINESS PHONE: 480-590-5701 MAIL ADDRESS: STREET 1: 6320 EAST THOMAS ROAD STREET 2: SUITE 100 CITY: SCOTTSDALE STATE: AZ ZIP: 85251 D 1 primary_doc.xml X0708 D LIVE 0001819319 IMAGEN DENTAL PARTNERS, LLC 6320 EAST THOMAS ROAD, SUITE 100 SCOTTSDALE AZ ARIZONA 85251 480-590-5701 DELAWARE None None Limited Liability Company true 2020 0001834113 Imagen Distinctive Dental Support Services, LLC 6320 EAST THOMAS ROAD SUITE 100 SCOTTSDALE AZ ARIZONA 85251 480-590-5701 DELAWARE None None Limited Liability Company true 2020 Rezwan Manji 6320 East Thomas Road, Suite 100 Scottsdale AZ ARIZONA 85251 Executive Officer Michael Augins 6320 East Thomas Road, Suite 100 Scottsdale AZ ARIZONA 85251 Executive Officer Mike Augins is an executive officer of Imagen Dental Partners, LLC and Imagen Distinctive Dental Support Services, LLC. Other Health Care Decline to Disclose 06b false true false true true 0 531500 0 531500 false 0 0 0 0 true IMAGEN DENTAL PARTNERS, LLC /s/ Rezwan Manji Rezwan Manji Chief Executive Officer 2020-12-11