0001867564-21-000002.txt : 20211202 0001867564-21-000002.hdr.sgml : 20211202 20211202152944 ACCESSION NUMBER: 0001867564-21-000002 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20211202 DATE AS OF CHANGE: 20211202 EFFECTIVENESS DATE: 20211202 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: 021-423392 FILM NUMBER: 211466338 BUSINESS ADDRESS: STREET 1: 16220 N. SCOTTSDALE ROAD, SUITE 300 CITY: SCOTTSDALE STATE: AZ ZIP: 85254 BUSINESS PHONE: 480-590-5701 MAIL ADDRESS: STREET 1: 16220 N. SCOTTSDALE ROAD, SUITE 300 CITY: SCOTTSDALE STATE: AZ ZIP: 85254 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Imagen Forest City Dental Support Services, LLC CENTRAL INDEX KEY: 0001867564 IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-423392-01 FILM NUMBER: 211466339 BUSINESS ADDRESS: STREET 1: 16220 N. SCOTTSDALE ROAD STREET 2: SUITE 300 CITY: SCOTTSDALE STATE: AZ ZIP: 85254 BUSINESS PHONE: 480-590-5701 MAIL ADDRESS: STREET 1: 16220 N. SCOTTSDALE ROAD STREET 2: SUITE 300 CITY: SCOTTSDALE STATE: AZ ZIP: 85254 D 1 primary_doc.xml X0708 D LIVE 0001819319 IMAGEN DENTAL PARTNERS, LLC 16220 N. SCOTTSDALE ROAD, SUITE 300 SCOTTSDALE AZ ARIZONA 85254 480-590-5701 DELAWARE None None Limited Liability Company true 2020 0001867564 Imagen Forest City Dental Support Services, LLC 16220 N. SCOTTSDALE ROAD SUITE 300 SCOTTSDALE AZ ARIZONA 85254 480-590-5701 DELAWARE None None Limited Liability Company true 2021 REZWAN MANJI 16220 N. SCOTTSDALE RD. SUITE 300 SCOTTSDALE AZ ARIZONA 85254 Executive Officer MICHAEL AUGINS 16220 N. Scottsdale Road SUITE 300 SUITE 300 AZ ARIZONA 85254 Executive Officer Michael Augins is an executive officer of Imagen Dental Partners, LLC and Imagen Forest City Dental Support Services, LLC Other Health Care Decline to Disclose 06b false 2021-11-30 false true true 0 286500 286500 0 false 0 0 0 0 true IMAGEN DENTAL PARTNERS, LLC /S/ Rezwan Manji Rezwan Manji Chief Executive Officer 2021-12-02