0002061701-25-000001.txt : 20250320 0002061701-25-000001.hdr.sgml : 20250320 20250320135008 ACCESSION NUMBER: 0002061701-25-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20250320 DATE AS OF CHANGE: 20250320 EFFECTIVENESS DATE: 20250320 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Imagen Fort Loramie Dental Support Services, LLC CENTRAL INDEX KEY: 0002061701 ORGANIZATION NAME: IRS NUMBER: 333362651 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-541569 FILM NUMBER: 25755698 BUSINESS ADDRESS: STREET 1: 16220 NORTH SCOTTSDALE ROAD STREET 2: SUITE 400 CITY: SCOTTSDALE STATE: AZ ZIP: 85254 BUSINESS PHONE: (480) 590-3396 MAIL ADDRESS: STREET 1: 16220 NORTH SCOTTSDALE ROAD STREET 2: SUITE 400 CITY: SCOTTSDALE STATE: AZ ZIP: 85254 FILER: COMPANY DATA: COMPANY CONFORMED NAME: IMAGEN DENTAL PARTNERS, LLC CENTRAL INDEX KEY: 0001819319 ORGANIZATION NAME: IRS NUMBER: 845189859 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-541569-01 FILM NUMBER: 25755699 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 0002061701 Imagen Fort Loramie Dental Support Services, LLC 16220 NORTH SCOTTSDALE ROAD SUITE 400 SCOTTSDALE AZ ARIZONA 85254 (480) 590-3396 DELAWARE None None Limited Liability Company true 2025 0001819319 IMAGEN DENTAL PARTNERS, LLC 16220 NORTH SCOTTSDALE ROAD SUITE 400 SCOTTSDALE AZ ARIZONA 85254 (480) 590-3396 DELAWARE None None Limited Liability Company true 2020 Rezwan Manji 16220 N. SCOTTSDALE ROAD SUITE 400 Scottsdale AZ ARIZONA 85254 Executive Officer Rezwan Manji is an executive officer of Imagen Dental Partners, LLC and Imagen Fort Loramie Dental Support Services, LLC. Michael Augins 16220 N. SCOTTSDALE ROAD SUITE 400 Scottsdale AZ ARIZONA 85254 Executive Officer Michael Augins is an executive officer of Imagen Dental Partners, LLC and Imagen Fort Loramie Dental Support Services, LLC. Other Health Care Decline to Disclose 06b false 2025-03-19 false true true 0 598072 598072 0 false 1 0 0 0 false Imagen Fort Loramie Dental Support Services, LLC /s/ Rezwan Manji Rezwan Manji Chief Executive Officer 2025-03-20 IMAGEN DENTAL PARTNERS, LLC /s/ Rezwan Manji Rezwan Manji Chief Executive Officer 2025-03-20