WHATLEY FAMILY DENTISTRY LLC

Contacts

Phone	+1 334-585-5400
Fax	3345856800

Authorized person

Name	JUSTIN WADE WHATLEY
Role	MANAGER/DENTIST
Phone	3345855400

Taxonomy

Taxonomy Code	1223G0001X - General Practice Dentistry
License Number	5836
State	AL
Is Primary	Yes

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2019-02-15
Business code	621210
Sponsor’s telephone number	3345855400
Plan sponsor’s address	301 DOTHAN ROAD, ABBEVILLE, AL, 36310

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2019-02-15
Business code	621210
Sponsor’s telephone number	3345855400
Plan sponsor’s address	301 DOTHAN ROAD, ABBEVILLE, AL, 36310

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2019-02-15
Business code	621210
Sponsor’s telephone number	3345855400
Plan sponsor’s address	301 DOTHAN ROAD, ABBEVILLE, AL, 36310

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2019-02-15
Business code	621210
Sponsor’s telephone number	3345855400
Plan sponsor’s address	301 DOTHAN ROAD, ABBEVILLE, AL, 36310

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2019-02-15
Business code	621210
Sponsor’s telephone number	3348585400
Plan sponsor’s address	45-2593234, ABBEVILLE, AL, 36310

Signature of

Role	Plan administrator
Date	2020-07-22
Name of individual signing	JUSTIN WADE WHATLEY