| Name: | Pine Belt Dental LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 26 Apr 2012 (13 years ago) (Companies founded in April 2012) |
| Entity Number: | 000-032-873 |
| Register Number: | 000032873 |
| ZIP code: | 36904 (Companies in Choctaw, 36904) |
| County: | Choctaw |
| Place of Formation: | Choctaw County |
| Principal Address: | 123 WEST ALABAMA STBUTLER, AL 36904 |
| Registered Office Mailing Address: | P O BOX 129GROVE HILL, AL 36451 |
| Registered Office Street Address: | 297C SOUTH JACKSON STREETGROVE HILL, AL 36451 |
Activities
OWN/MANAGE/OPERATE GENERAL DENTAL PRACTICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144588906 | 2012-04-30 | 2012-04-30 | 297C S JACKSON ST, P O BOX 129, GROVE HILL, AL, 364513231, US | 297C S JACKSON ST, GROVE HILL, AL, 364513231, US | |||||||||||||||||||||||||||||||
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| Phone | +1 251-275-3822 |
| Fax | 2512754190 |
Authorized person
| Name | DR. JIMMY C WHITE |
| Role | GENERAL PARTNER |
| Phone | 2512753822 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | AL3287 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NATIONAL PROVIDER IDENTIFIER |
| Number | 1962737916 |
| State | AL |
| Issuer | NATIONAL PROVIDER IDENTIFIER |
| Number | 1558445999 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| WHITE, JIMMY C | Organizer | 1120 JEFF STBUTLER, AL 36904 |
| MORRIS, W BRITT | Organizer | 123 WEST ALABAMA STBUTLER, AL 36904 |
| Name | Role | Address |
|---|---|---|
| JIMMY C. WHITE DMD | Member | 297C SOUTH JACKSON STREETGROVE HILL, AL 36451 |
| Name | Role | Address |
|---|---|---|
| JIMMY C. WHITE DMD | Agent | 297C SOUTH JACKSON STREETGROVE HILL, AL 36451 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
