0001941680-22-000001.txt : 20220808 0001941680-22-000001.hdr.sgml : 20220808 20220808111200 ACCESSION NUMBER: 0001941680-22-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20220808 DATE AS OF CHANGE: 20220808 EFFECTIVENESS DATE: 20220808 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Imagen Beach Teeth Support Services, LLC CENTRAL INDEX KEY: 0001941680 IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-455172 FILM NUMBER: 221143139 BUSINESS ADDRESS: STREET 1: 16220 NORTH SCOTTSDALE ROAD STREET 2: SUITE 300 CITY: SCOTTSDALE STATE: AZ ZIP: 85254 BUSINESS PHONE: 4805903396 MAIL ADDRESS: STREET 1: 16220 NORTH 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: 021-455172-01 FILM NUMBER: 221143140 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 0001941680 Imagen Beach Teeth Support Services, LLC 16220 NORTH SCOTTSDALE ROAD SUITE 300 SCOTTSDALE AZ ARIZONA 85254 (480) 590-3396 DELAWARE None None Limited Liability Company true 2022 0001819319 IMAGEN DENTAL PARTNERS, LLC 16220 NORTH SCOTTSDALE ROAD SUITE 300 SCOTTSDALE AZ ARIZONA 85254 (480) 590-3396 DELAWARE None None Limited Liability Company true 2020 Rezwan Manji 16220 North Scottsdale Road Suite 300 Scottsdale AZ ARIZONA 85254 Executive Officer Rezwan Manji is an executive officer of Imagen Beach Teeth Dental Support Services, LLC and Imagen Dental Partners.com. Michael Augins 16220 North Scottsdale Road Suite 300 Scottsdale AZ ARIZONA 85254 Executive Officer Michael Augins is an executive officer of Imagen Beach Teeth Dental Support Services, LLC and Imagen Dental Partners.com. Other Health Care Decline to Disclose 06b false 2022-07-21 false true true 0 1265000 1265000 0 false 1 0 0 0 true Imagen Beach Teeth Support Services, LLC /s/ Rezwan Manji Rezwan Manji Chief Executive Officer 2022-08-08