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Michael A. Keller, D.D.S., P.C.

Details

Name: Michael A. Keller, D.D.S., P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 01 Oct 1975 (49 years ago)
Entity Number: 000-039-511
Register Number: 000039511
Historical Names: Bob L. Roebuck, D.M.D., P.A.
County: Jefferson
Place of Formation: Jefferson County
Registered Office Street Address: 2045 BROOKWOOD MEDICAL CENTER DRBIRMINGHAM, AL 35209
Registered Office Street Address ZIP Code: 35209
Authorized Capital: $1,000

Activities PRACTICE OF DENTISTRY/ORAL SURGERY/PERIODONTIA/ORTHODONITA ETC

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1801925656 2007-03-05 2020-08-22 2045 BROOKWOOD MEDICAL CTR DR, SUITE 5-7, BIRMINGHAM, AL, 352096874, US 2045 BROOKWOOD MEDICAL CTR DR, SUITE 5-7, BIRMINGHAM, AL, 352096874, US

Contacts
Phone +1 205-870-7110
Fax 2058713339

Authorized person
Name DR. MICHAEL AAON KELLER
Role PEDIATRIC DENTIST
Phone 2058707110

Taxonomy
Taxonomy Code 1223P0221X - Pediatric Dentist
License Number 4936
State AL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MICHAEL A. KELLER, D.D.S., P.C. PROFIT SHARING PLAN 2020 630695110 2021-10-13 MICHAEL A. KELLER, D.D.S., P.C. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-28
Business code 621210
Sponsor’s telephone number 2058707110
Plan sponsor’s address 2045 MEDICAL CENTER DRIVE, BIRMINGHAM, AL, 35209

Signature of
Role Plan administrator
Date 2021-10-13
Name of individual signing MICHAEL A. KELLER
Role Employer/plan sponsor
Date 2021-10-13
Name of individual signing MICHAEL A. KELLER
MICHAEL A. KELLER, D.D.S., P.C. PROFIT SHARING PLAN 2019 630695110 2020-10-14 MICHAEL A. KELLER, D.D.S., P.C. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-28
Business code 621210
Sponsor’s telephone number 2058707110
Plan sponsor’s address 2045 MEDICAL CENTER DRIVE, BIRMINGHAM, AL, 35209

Signature of
Role Plan administrator
Date 2020-10-14
Name of individual signing MICHAEL A. KELLER
Role Employer/plan sponsor
Date 2020-10-14
Name of individual signing MICHAEL A. KELLER
MICHAEL A. KELLER, D.D.S., P.C. PROFIT SHARING PLAN 2018 630695110 2019-10-11 MICHAEL A. KELLER, D.D.S., P.C. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-28
Business code 621210
Sponsor’s telephone number 2058707110
Plan sponsor’s address 2045 MEDICAL CENTER DRIVE, BIRMINGHAM, AL, 35209

Signature of
Role Plan administrator
Date 2019-10-11
Name of individual signing MICHAEL A. KELLER
Role Employer/plan sponsor
Date 2019-10-11
Name of individual signing MICHAEL A. KELLER
MICHAEL A. KELLER, D.D.S., P.C. PROFIT SHARING PLA 2017 630695110 2018-10-11 MICHAEL A. KELLER, D.D.S., P.C. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-28
Business code 621210
Sponsor’s telephone number 2058707110
Plan sponsor’s address 2045 MEDICAL CENTER DRIVE, BIRMINGHAM, AL, 35209

Signature of
Role Plan administrator
Date 2018-10-11
Name of individual signing MICHAEL A. KELLER
Role Employer/plan sponsor
Date 2018-10-11
Name of individual signing MICHAEL A. KELLER
MICHAEL A. KELLER, D.D.S., P.C. PROFIT SHARING PLA 2016 630695110 2017-10-11 MICHAEL A. KELLER, D.D.S., P.C. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-28
Business code 621210
Sponsor’s telephone number 2058707110
Plan sponsor’s address 2045 MEDICAL CENTER DRIVE, BIRMINGHAM, AL, 35209

Signature of
Role Plan administrator
Date 2017-10-11
Name of individual signing MICHAEL A. KELLER
Role Employer/plan sponsor
Date 2017-10-11
Name of individual signing MICHAEL A. KELLER
MICHAEL A. KELLER, D.D.S., P.C. PROFIT SHARING PLA 2015 630695110 2016-10-11 MICHAEL A. KELLER, D.D.S., P.C. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-28
Business code 621210
Sponsor’s telephone number 2058707110
Plan sponsor’s address 2045 MEDICAL CENTER DRIVE, BIRMINGHAM, AL, 35209

Signature of
Role Plan administrator
Date 2016-10-11
Name of individual signing MICHAEL A. KELLER
Role Employer/plan sponsor
Date 2016-10-11
Name of individual signing MICHAEL A KELLER
MICHAEL A. KELLER, D.D.S., P.C. PROFIT SHARING PL 2014 630695110 2015-10-09 MICHAEL A. KELLER, D.D.S., P.C. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-28
Business code 621210
Sponsor’s telephone number 2058707110
Plan sponsor’s address 2045 MEDICAL CENTER DRIVE, BIRMINGHAM, AL, 35209

Signature of
Role Plan administrator
Date 2015-10-09
Name of individual signing MICHAEL A. KELLER
Role Employer/plan sponsor
Date 2015-10-09
Name of individual signing MICHAEL A KELLER
MICHAEL A. KELLER, D.D.S., P.C. PROFIT SHARING PL 2013 630695110 2014-09-22 MICHAEL A. KELLER, D.D.S., P.C. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-28
Business code 621210
Sponsor’s telephone number 2058707110
Plan sponsor’s address 2045 MEDICAL CENTER DRIVE, BIRMINGHAM, AL, 35209

Signature of
Role Plan administrator
Date 2014-09-22
Name of individual signing MICHAEL A. KELLER
Role Employer/plan sponsor
Date 2014-09-22
Name of individual signing MICHAEL A KELLER
MICHAEL A. KELLER, D.D.S., P.C. PROFIT SHARING PL 2012 630695110 2013-09-06 MICHAEL A. KELLER, D.D.S., P.C. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-28
Business code 621210
Sponsor’s telephone number 2058707110
Plan sponsor’s address 2045 MEDICAL CENTER DRIVE, BIRMINGHAM, AL, 35209

Signature of
Role Plan administrator
Date 2013-09-06
Name of individual signing MICHAEL A. KELLER

Agent

Name Role
KELLER, MICHAEL A Agent

Incorporator

Name Role
ROEBUCK, BOB L Incorporator

Events

Event Date Event Type Old Value New Value
1999-02-05 Name Change Bob L. Roebuck, D.M.D., P.A. Michael A. Keller, D.D.S., P.C.
1999-02-05 Capital Change --- Authorized --- Paid In $1,000 Authorized undefined Paid In

Related by officers

KELLER, MICHAEL A

Brookwood Dental Arts Building, L.L.C.

Related by address

2045 BROOKWOOD MEDICAL CENTER DRBIRMINGHAM, AL 35209

Connor Brothers, L.L.C.

Date of last update: 30 Jul 2024

Sources: Alabama Secretary of State

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