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Organization

IMAGINE ORTHODONTIC STUDIO PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MICHAEL ANDREW HESS DMD, MS (OWNER)
(727) 743-8307
Entity
Organization

Contact information

Practice address
11502 N 56TH ST, TEMPLE TERRACE, FL 33617-2239
(863) 462-4463
Mailing address
3595 S FLORIDA AVE, LAKELAND, FL 33803-4860
(863) 462-4463

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1223X0400X
FL
Enumeration date
06/03/2021
Last updated
06/03/2021
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