MEDICARE: IMAGINE ORTHODONTICS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1154255321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMAGINE ORTHODONTICS, LLC

Provider Business Mailing Address
First Line	:	1075 ZONOLITE RD NE STE 1C
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-2013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 ZONOLITE RD NE STE 1C
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-2013
Country	:	US
Telephone Number	:	404-449-0745
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. INDIA COLLIER
Credential	:	DMD
Telephone Number	:	404-449-0745

Provider Enumeration Date	:	06/11/2026
Last Update Date	:	06/11/2026

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