MEDICARE: IMAGEN HART, DDS, 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1174344709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMAGEN HART, DDS, LLC

Provider Business Mailing Address
First Line	:	3735 CANTON RD
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-2663
Country	:	US
Telephone Number	:	770-926-8371
Fax Number	:

Provider Business Practice Location Address
First Line	:	3735 CANTON RD
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-2663
Country	:	US
Telephone Number	:	770-926-8371
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	BELLA ZARITSKY
Credential	:
Telephone Number	:	480-482-1070

Provider Enumeration Date	:	10/17/2024
Last Update Date	:	10/17/2024

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