0001819319-21-000006.txt : 20210429 0001819319-21-000006.hdr.sgml : 20210429 20210429164809 ACCESSION NUMBER: 0001819319-21-000006 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20210429 DATE AS OF CHANGE: 20210429 EFFECTIVENESS DATE: 20210429 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: 021-397698 FILM NUMBER: 21871532 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 Scripps Rock Dental Support Services, LLC CENTRAL INDEX KEY: 0001849323 IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-397698-01 FILM NUMBER: 21871533 BUSINESS ADDRESS: STREET 1: 6320 EAST THOMAS ROAD STREET 2: SUITE 100 CITY: SCOTTSDALE STATE: AZ ZIP: 85251 BUSINESS PHONE: 4805905701 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 0001849323 Imagen Scripps Rock Dental Support Services, LLC 6320 EAST THOMAS ROAD SUITE 100 SCOTTSDALE AZ ARIZONA 85251 4805905701 DELAWARE None None Limited Liability Company true 2021 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 Michael Augins is an executive officer of Imagen Dental Partners, LLC and Imagen Scripps Rock Dental Support Services, LLC Other Health Care Decline to Disclose 06b false true false true true 0 1502500 0 1502500 false 0 0 0 0 true IMAGEN DENTAL PARTNERS, LLC /s/ Rezwan Manji Rezwan Manji Chief Executive Officer 2021-04-29