Organization
IMAGINE ORTHODONTIC STUDIO PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAIYAL POPAT (OWNER)
(407) 758-5424
Entity
Organization
Contact information
Practice address
3595 S FLORIDA AVE, LAKELAND, FL 33803-4860
(727) 743-8307
Mailing address
3595 S FLORIDA AVE, LAKELAND, FL 33803-4860
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
03/10/2020
Last updated
05/11/2020
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