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General NPI Number Information
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NPI Number | 1154047819
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Entity Type | Organization
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Legal Business Name | IMAGINE ORTHODONTIC STUDIO PLLC
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Dates
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Enumeration Date | 10/14/2022
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Last Update Date | 10/14/2022
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Provider Practice Location Address
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Address Line | 1581 MISSOURI AVE N
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City | LARGO
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State | FL
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Zip | 33770-1853
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Country | US
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Telephone | 727-724-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 7348 US 19 N
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City | PINELLAS PARK
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State | FL
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Zip | 33781-4600
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Country | US
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Telephone | 727-865-5711
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL ANDREW HESS
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Credential | DMD, MS
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Telephone | 727-743-8307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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