0001920225-22-000001.txt : 20220329 0001920225-22-000001.hdr.sgml : 20220329 20220329151509 ACCESSION NUMBER: 0001920225-22-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20220329 DATE AS OF CHANGE: 20220329 EFFECTIVENESS DATE: 20220329 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Imagen Walled Lake Support Services, LLC CENTRAL INDEX KEY: 0001920225 IRS NUMBER: 872791999 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-439443 FILM NUMBER: 22780282 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 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: 021-439443-01 FILM NUMBER: 22780283 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 D 1 primary_doc.xml X0708 D LIVE 0001920225 Imagen Walled Lake Support Services, LLC 16220 N. SCOTTSDALE ROAD SUITE 300 SCOTTSDALE AZ ARIZONA 85254 480-590-5701 DELAWARE None None Limited Liability Company true 2022 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 Rezwan Manji 16220 North Scottsdale Road Suite 300 Scottsdale AZ ARIZONA 85254 Executive Officer Michael Augins 16220 N. Scottsdale Road SUITE 300 Scottsdale AZ ARIZONA 85254 Executive Officer Michael Augins is an executive officer of Imagen Dental Partners, LLC and Imagen Walled Lake Support Services, LLC Other Health Care Decline to Disclose 06b false 2022-03-16 false true true 0 977000 977000 0 false 1 0 0 0 true Imagen Walled Lake Support Services, LLC /s/ Rezwan Manji Rezwan Manji Chief Executive Officer 2022-03-16