| Name: | Shelby Oral Facial Surgery, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 08 Dec 2011 (13 years ago) |
| Entity Number: | 000-033-327 |
| Register Number: | 000033327 |
| County: | Montgomery |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 2 NORTH JACKSON STREET, SUITE 605MONTGOMERY, AL 36104 |
| Registered Office Street Address ZIP Code: | 36104 |
| Authorized Capital: | 5,000 @ $1.00PV |
Activities
PRACTICE OF DENTISTRY
SPECIALIZING IN ORAL AND MAXILLOFACIAL
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447643523 | 2015-03-12 | 2015-03-12 | 1 INVERNESS CENTER PKWY, SUITE 200, BIRMINGHAM, AL, 352424817, US | 1 INVERNESS CENTER PKWY, SUITE 200, BIRMINGHAM, AL, 352424817, US | |||||||||||||||||||
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| Phone | +1 205-789-5075 |
| Fax | 2055585775 |
Authorized person
| Name | DR. LISA L MILLER |
| Role | OWNER/PROVIDER |
| Phone | 2057895075 |
Taxonomy
| Taxonomy Code | 1223S0112X - Oral and Maxillofacial Surgery (Dentist) |
| License Number | 5364 |
| State | AL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| C T CORPORATION SYSTEM | Agent | 2 NORHT JACKSON STREET SUITE 605MONTGOMERY, AL 36104 |
| Name | Role | Address |
|---|---|---|
| EVERTS, JOSHUA EDWARD | Director | 2347 TYLER ROADBIRMINGHAM, AL 35226 |
| LIVINGSTON, NICHOLAS RYAN | Director | 4227 ASHINGTON DRIVEBIRMINGHAM, AL 35242 |
| Name | Role | Address |
|---|---|---|
| EVERTS, JOSHUA E | Incorporator | 4440 CALDWELL MILL ROADMOUNTAIN BROOK, AL 35243 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
