0001942693-22-000001.txt : 20220812 0001942693-22-000001.hdr.sgml : 20220812 20220812133211 ACCESSION NUMBER: 0001942693-22-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20220812 DATE AS OF CHANGE: 20220812 EFFECTIVENESS DATE: 20220812 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Imagen Lakeshore Dental Support Services, LLC CENTRAL INDEX KEY: 0001942693 IRS NUMBER: 883222397 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-455830 FILM NUMBER: 221159205 BUSINESS ADDRESS: STREET 1: 16220 NORTH SCOTTSDALE ROAD STREET 2: SUITE 300 CITY: SCOTTSDALE STATE: AZ ZIP: 85254 BUSINESS PHONE: (480) 590-3396 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: 021-455830-01 FILM NUMBER: 221159206 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 0001942693 Imagen Lakeshore Dental 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 N. SCOTTSDALE ROAD SUITE 300 SCOTTSDALE AZ ARIZONA 85254 (480) 590-3396 DELAWARE None None Limited Liability Company true 2020 Michael Augins 16220 North Scottsdale Road Suite 300 Scottsdale AZ ARIZONA 85254 Executive Officer Michael Augins is an executive officer of Imagen Lakeshore Dental Support Services, LLC and Imagen Dental Partners, LLC. Rezwan Manji 16220 North Scottsdale Road Suite 300 Scottsdale AZ ARIZONA 85254 Executive Officer Rezwan Manji is an executive officer of Imagen Lakeshore Dental Support Services, LLC and Imagen Dental Partners, LLC. Other Health Care Decline to Disclose 06b false 2022-08-03 false true true 0 326000 326000 0 false 1 0 0 0 true Imagen Lakeshore Dental Support Services, LLC /s/ Michael Augins Michael Augins President 2022-08-12