NPIMap

Organization Active NPI

Imagine Dental & Orthodontics LLC

  • General Practice Dentistry
  • Ankeny, IA
National Provider Identifier
1386348787
Registry record updated Mar 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
IMAGINE DENTAL & ORTHODONTICS LLC
Practice address
201 S Ankeny Blvd
Ankeny, IA 50023-3116
Phone
(515) 964-5602
NPI assigned
Mar 29, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Thomas Benton RollinsNPI 1942452099
Title
Owner
Phone
(850) 393-9476

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X

Addresses

Primary practice location

201 S Ankeny Blvd
Ankeny, IA 50023-3116

Mailing address

201 S Ankeny Blvd
Ankeny, IA 50023-3116
Phone (515) 964-5602

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1680048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680048000000",
    "number": "1386348787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 S ANKENY BLVD",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500233116",
            "telephone_number": "515-964-5602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S ANKENY BLVD",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500233116",
            "telephone_number": "515-964-5602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGINE DENTAL & ORTHODONTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-29",
        "last_updated": "2023-03-29",
        "certification_date": "2023-03-29",
        "status": "A",
        "authorized_official_last_name": "ROLLINS",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "BENTON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-393-9476"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ankeny, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.