| Imagine Orthodontic Studio Pllc | |
|
11502 N 56th St Temple Terrace FL 33617-2239 | |
| (863) 462-4463 | |
| Not Available |
| Full Name | Imagine Orthodontic Studio Pllc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 11502 N 56th St, Temple Terrace, Florida |
| Authorized Official Name and Position | Michael Andrew Hess (OWNER) |
| Authorized Official Contact | 7277438307 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Imagine Orthodontic Studio Pllc 3595 S Florida Ave Lakeland FL 33803-4860 Ph: (863) 462-4463 | Imagine Orthodontic Studio Pllc 11502 N 56th St Temple Terrace FL 33617-2239 Ph: (863) 462-4463 |
| NPI Number | 1285200782 |
|---|---|
| Provider Enumeration Date | 06/03/2021 |
| Last Update Date | 06/03/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285200782 | NPI | - | NPPES |
| 1223X0400X | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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