Organization
IMAGINE DENTAL & ORTHODONTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS BENTON ROLLINS (OWNER)
(850) 393-9476
Entity
Organization
Contact information
Practice address
201 S ANKENY BLVD, ANKENY, IA 50023-3116
(515) 964-5602
Mailing address
201 S ANKENY BLVD, ANKENY, IA 50023-3116
(515) 964-5602
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
03/29/2023
Last updated
03/29/2023
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