Organization
IMAGINE ORTHODONTIC STUDIO
Active
Organization
IMAGINE ORTHODONTIC STUDIO
Active
Parent organization
000000
Other names
Imagine St. Pete
Organization subpart
Yes
Provider details
NPI number
Legal business name
000000
Authorized official
MARIELLA CARRENO (OFFICE MANAGER)
(863) 462-4463
Entity
Organization
Contact information
Practice address
7348 US HIGHWAY 19 N, PINELLAS PARK, FL 33781-4600
(727) 865-5711
Mailing address
11502 N 56TH ST, TEMPLE TERRACE, FL 33617-2239
(813) 212-1313
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
01/25/2022
Last updated
01/25/2022
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