0001957273-22-000001.txt : 20221215 0001957273-22-000001.hdr.sgml : 20221215 20221215120640 ACCESSION NUMBER: 0001957273-22-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20221215 DATE AS OF CHANGE: 20221215 EFFECTIVENESS DATE: 20221215 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Imagen Corvallis Support Services, LLC CENTRAL INDEX KEY: 0001957273 IRS NUMBER: 921088866 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-467547 FILM NUMBER: 221464230 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: 021-467547-01 FILM NUMBER: 221464231 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 0001957273 Imagen Corvallis 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 Dental Partners, LLC and Imagen Corvallis Support Services, LLC. Michael Augins 16220 NORTH SCOTTSDALE ROAD SUITE 300 SCOTTSDALE AZ ARIZONA 85254 Executive Officer Michael Augins is an executive officer of Imagen Dental Partners, LLC and Imagen Corvallis Support Services, LLC. Other Health Care Decline to Disclose 06b false 2022-12-14 false true true 0 733000 733000 0 false 1 0 0 0 false Imagen Corvallis Support Services, LLC /s/ Rezwan Manji Rezwan Manji Chief Executive Officer 2022-12-15 IMAGEN DENTAL PARTNERS, LLC /s/ Rezwan Manji Rezwan Manji Chief Executive Officer 2022-12-15