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Complete Dental of Mobile, LLC

Details

Name: Complete Dental of Mobile, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 31 Aug 2011 (13 years ago) (Companies founded in August 2011)
Entity Number: 000-024-331
Register Number: 000024331
ZIP code: 36619 (Companies in Mobile, 36619)
County: Mobile
Place of Formation: Mobile County
Registered Office Street Address: 5651 THREE NOTCH RDMOBILE, AL 36619

Activities ANY LAWFUL BUSINESS

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1790066728 2011-09-03 2011-12-06 5651 THREE NOTCH RD, MOBILE, AL, 366191617, US 5651 THREE NOTCH RD, MOBILE, AL, 366191617, US

Contacts
Phone +1 251-661-1003
Fax 2516612709

Authorized person
Name DR. SHAUN GARY SMALL
Role OWNER
Phone 2516611003

Taxonomy
Taxonomy Code 261QD0000X - Dental Clinic/Center
License Number 5565
State AL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
COMPLETE DENTAL OF MOBILE LLC 401(K) PS PLAN 2023 453133198 2024-07-29 COMPLETE DENTAL OF MOBILE LLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621210
Sponsor’s telephone number 2516611003
Plan sponsor’s address 5651 THREE NOTCH RD, MOBILE, AL, 36619

Signature of
Role Plan administrator
Date 2024-07-29
Name of individual signing SHAUN G SMALL
COMPLETE DENTAL OF MOBILE LLC 401(K) P/S PLAN 2022 453133198 2023-06-06 COMPLETE DENTAL OF MOBILE LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621210
Sponsor’s telephone number 2516611003
Plan sponsor’s address 5651 THREE NOTCH RD., MOBILE, AL, 36619

Plan administrator’s name and address
Administrator’s EIN 453133198
Plan administrator’s name COMPLETE DENTAL OF MOBILE LLC
Plan administrator’s address 5651 THREE NOTCH RD., MOBILE, AL, 36619
Administrator’s telephone number 2516611003

Signature of
Role Plan administrator
Date 2023-06-06
Name of individual signing SHAUN SMALL
COMPLETE DENTAL OF MOBILE LLC 401(K) P/S PLAN 2021 453133198 2022-07-19 COMPLETE DENTAL OF MOBILE LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621210
Sponsor’s telephone number 2516611003
Plan sponsor’s address 5651 THREE NOTCH RD., MOBILE, AL, 36619

Plan administrator’s name and address
Administrator’s EIN 453133198
Plan administrator’s name COMPLETE DENTAL OF MOBILE LLC
Plan administrator’s address 5651 THREE NOTCH RD., MOBILE, AL, 36619
Administrator’s telephone number 2516611003

Signature of
Role Plan administrator
Date 2022-07-19
Name of individual signing SHAUN SMALL
COMPLETE DENTAL OF MOBILE LLC 401(K) P/S PLAN 2020 453133198 2021-06-01 COMPLETE DENTAL OF MOBILE LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621210
Sponsor’s telephone number 2516611003
Plan sponsor’s address 5651 THREE NOTCH RD., MOBILE, AL, 36619

Plan administrator’s name and address
Administrator’s EIN 453133198
Plan administrator’s name COMPLETE DENTAL OF MOBILE LLC
Plan administrator’s address 5651 THREE NOTCH RD., MOBILE, AL, 36619
Administrator’s telephone number 2516611003

Signature of
Role Plan administrator
Date 2021-06-01
Name of individual signing SHAUN SMALL
COMPLETE DENTAL OF MOBILE LLC 401(K) P/S PLAN 2019 453133198 2020-08-19 COMPLETE DENTAL OF MOBILE LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621210
Sponsor’s telephone number 2516611003
Plan sponsor’s address 5651 THREE NOTCH RD., MOBILE, AL, 36619

Plan administrator’s name and address
Administrator’s EIN 453133198
Plan administrator’s name COMPLETE DENTAL OF MOBILE LLC
Plan administrator’s address 5651 THREE NOTCH RD., MOBILE, AL, 36619
Administrator’s telephone number 2516611003

Signature of
Role Plan administrator
Date 2020-08-19
Name of individual signing SHAUN SMALL
COMPLETE DENTAL OF MOBILE LLC 401(K) P/S PLAN 2018 453133198 2019-03-07 COMPLETE DENTAL OF MOBILE LLC 8
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621210
Sponsor’s telephone number 2516611003
Plan sponsor’s address 5651 THREE NOTCH RD., MOBILE, AL, 36619

Plan administrator’s name and address
Administrator’s EIN 453133198
Plan administrator’s name COMPLETE DENTAL OF MOBILE LLC
Plan administrator’s address 5651 THREE NOTCH RD., MOBILE, AL, 36619
Administrator’s telephone number 2516611003

Signature of
Role Plan administrator
Date 2019-03-07
Name of individual signing SHAUN SMALL
COMPLETE DENTAL OF MOBILE LLC 401(K) P/S PLAN 2018 453133198 2019-04-02 COMPLETE DENTAL OF MOBILE LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621210
Sponsor’s telephone number 2516611003
Plan sponsor’s address 5651 THREE NOTCH RD., MOBILE, AL, 36619

Plan administrator’s name and address
Administrator’s EIN 453133198
Plan administrator’s name COMPLETE DENTAL OF MOBILE LLC
Plan administrator’s address 5651 THREE NOTCH RD., MOBILE, AL, 36619
Administrator’s telephone number 2516611003

Signature of
Role Plan administrator
Date 2019-04-02
Name of individual signing SHAUN SMALL
COMPLETE DENTAL OF MOBILE LLC 401(K) P/S PLAN 2017 453133198 2018-04-24 COMPLETE DENTAL OF MOBILE LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621210
Sponsor’s telephone number 2516611003
Plan sponsor’s address 5651 THREE NOTCH RD., MOBILE, AL, 36619

Plan administrator’s name and address
Administrator’s EIN 453133198
Plan administrator’s name COMPLETE DENTAL OF MOBILE LLC
Plan administrator’s address 5651 THREE NOTCH RD., MOBILE, AL, 36619
Administrator’s telephone number 2516611003

Signature of
Role Plan administrator
Date 2018-04-24
Name of individual signing SHAUN SMALL
COMPLETE DENTAL OF MOBILE LLC 401(K) P/S PLAN 2016 453133198 2017-07-31 COMPLETE DENTAL OF MOBILE LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621210
Sponsor’s telephone number 2516611003
Plan sponsor’s address 5651 THREE NOTCH RD., MOBILE, AL, 36619

Plan administrator’s name and address
Administrator’s EIN 453133198
Plan administrator’s name COMPLETE DENTAL OF MOBILE LLC
Plan administrator’s address 5651 THREE NOTCH RD., MOBILE, AL, 36619
Administrator’s telephone number 2516611003

Signature of
Role Plan administrator
Date 2017-07-31
Name of individual signing SHAUN SMALL
COMPLETE DENTAL OF MOBILE LLC 401(K) P/S PLAN 2015 453133198 2016-07-21 COMPLETE DENTAL OF MOBILE LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621210
Sponsor’s telephone number 2516611003
Plan sponsor’s address 5651 THREE NOTCH RD., MOBILE, AL, 36619

Plan administrator’s name and address
Administrator’s EIN 453133198
Plan administrator’s name COMPLETE DENTAL OF MOBILE LLC
Plan administrator’s address 5651 THREE NOTCH RD., MOBILE, AL, 36619
Administrator’s telephone number 2516611003

Signature of
Role Plan administrator
Date 2016-07-21
Name of individual signing SHAUN SMALL

Agent

Name Role Address
SMALL, SHAUN G DMD Agent 5651 THREE NOTCH RDMOBILE, AL 36619

Organizer

Name Role Address
SMALL, SHAUN G DMD Organizer 5651 THREE NOTCH RDMOBILE, AL 36619
WATKINS, JAMES F Organizer 103 LANIER AVENUEMOBILE, AL 36607

Related by officers

WATKINS, JAMES F

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Related by address

No related companies by address

Date of last update: 30 Jul 2024

Sources: Alabama Secretary of State

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