Benjamin D. Williams, DMD, PA

Details

Name:	Benjamin D. Williams, DMD, PA
Jurisdiction:	Alabama
Legal type:	Domestic Professional Association
Status:	Exists
Date of registration:	14 Sep 1976 (48 years ago) (Companies founded in September 1976)
Entity Number:	000-043-037
Register Number:	000043037
Historical Names:	M. Dale Williams, D.M.D., P.A.
ZIP code:	35212 (Companies in Jefferson, 35212)
County:	Jefferson
Place of Formation:	Jefferson County
Principal Address:	100 57TH STREET SOUTHBIRMINGHAM, AL 35212

Activities NOT PROVIDED

National Provider Identifier

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1265603823

2008-03-21

2019-06-17

100 57TH ST SO, BIRMINGHAM, AL, 35212, US

Contacts

Phone	+1 205-591-1101
Fax	2055920142

Authorized person

Name	BENJAMIN WILLIAMS
Role	OWNER
Phone	2055911101

Taxonomy

Taxonomy Code	122300000X - Dentist
Is Primary	Yes
Taxonomy Code	1223G0001X - General Practice Dentistry
Is Primary	No

Other Provider Identifiers

Issuer	MEDICAID
Number	529908410
State	AL

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

M. DALE WILLIAMS, P.A. PROFIT SHARING PLAN

2014

630714566

2016-06-15

M. DALE WILLIAMS, D.M.D., P.A.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1980-09-05
Business code	621210
Sponsor’s telephone number	2055911101
Plan sponsor’s address	100 57TH STREET SOUTH, BIRMINGHAM, AL, 35212

Signature of

Role	Plan administrator
Date	2016-06-15
Name of individual signing	M. DALE WILLIAMS

M. DALE WILLIAMS, D.M.D., P.A. CASH BALANCE PLAN AND TRUST

2013

630714566

2016-08-30

M. DALE WILLIAMS, D.M.D., P.A.

File	View Page
Three-digit plan number (PN)	003
Effective date of plan	2007-09-01
Business code	621210
Sponsor’s telephone number	2055911101
Plan sponsor’s address	912 BELGRAVE COURT, BIRMINGHAM, AL, 352427273

M. DALE WILLIAMS, P.A. PROFIT SHARING PLAN

2013

630714566

2015-06-15

M. DALE WILLIAMS, D.M.D., P.A.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1980-09-05
Business code	621210
Sponsor’s telephone number	2055911101
Plan sponsor’s address	100 57TH STREET SOUTH, BIRMINGHAM, AL, 35212

Signature of

Role	Plan administrator
Date	2015-06-15
Name of individual signing	M. DALE WILLIAMS

M. DALE WILLIAMS, D.M.D., P.A. CASH BALANCE PLAN AND TRUST

2012

630714566

2014-06-04

M. DALE WILLIAMS, D.M.D., P.A.

File	View Page
Three-digit plan number (PN)	003
Effective date of plan	2007-09-01
Business code	621210
Sponsor’s telephone number	2055911101
Plan sponsor’s address	912 BELGRAVE COURT, BIRMINGHAM, AL, 352427273

Signature of

Role	Plan administrator
Date	2014-06-04
Name of individual signing	M. DALE WILLIAMS

M. DALE WILLIAMS, P.A. PROFIT SHARING PLAN

2012

630714566

2014-06-16

M. DALE WILLIAMS, D.M.D., P.A.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1980-09-05
Business code	621210
Sponsor’s telephone number	2055911101
Plan sponsor’s address	100 57TH STREET SOUTH, BIRMINGHAM, AL, 35212

Signature of

Role	Plan administrator
Date	2014-06-16
Name of individual signing	M. DALE WILLIAMS

M. DALE WILLIAMS, D.M.D., P.A. CASH BALANCE PLAN AND TRUST

2011

630714566

2013-03-19

M. DALE WILLIAMS, D.M.D., P.A.

File	View Page
Three-digit plan number (PN)	003
Effective date of plan	2007-09-01
Business code	621210
Sponsor’s telephone number	2055911101
Plan sponsor’s address	912 BELGRAVE COURT, BIRMINGHAM, AL, 352427273

Plan administrator’s name and address

Administrator’s EIN	630714566
Plan administrator’s name	M. DALE WILLIAMS, D.M.D., P.A.
Plan administrator’s address	912 BELGRAVE COURT, BIRMINGHAM, AL, 352427273
Administrator’s telephone number	2055911101

Signature of

Role	Plan administrator
Date	2013-03-19
Name of individual signing	M. DALE WILLIAMS

M. DALE WILLIAMS, D.M.D., P.A. CASH BALANCE PLAN AND TRUST

2010

630714566

2011-12-07

M. DALE WILLIAMS, D.M.D., P.A.

File	View Page
Three-digit plan number (PN)	003
Effective date of plan	2007-09-01
Business code	621210
Sponsor’s telephone number	2055911101
Plan sponsor’s address	912 BELGRAVE COURT, BIRMINGHAM, AL, 352427273

Plan administrator’s name and address

Administrator’s EIN	630714566
Plan administrator’s name	M. DALE WILLIAMS, D.M.D., P.A.
Plan administrator’s address	912 BELGRAVE COURT, BIRMINGHAM, AL, 352427273
Administrator’s telephone number	2055911101

Signature of

Role	Plan administrator
Date	2011-12-07
Name of individual signing	M. DALE WILLIAMS

M. DALE WILLIAMS, D.M.D., P.A. CASH BALANCE PLAN AND TRUST

2009

630714566

2011-01-20

M. DALE WILLIAMS, D.M.D., P.A.

File	View Page
Three-digit plan number (PN)	003
Effective date of plan	2007-09-01
Business code	621210
Sponsor’s telephone number	2055911101
Plan sponsor’s address	912 BELGRAVE COURT, BIRMINGHAM, AL, 352427273

Plan administrator’s name and address

Administrator’s EIN	630714566
Plan administrator’s name	M. DALE WILLIAMS, D.M.D., P.A.
Plan administrator’s address	912 BELGRAVE COURT, BIRMINGHAM, AL, 352427273
Administrator’s telephone number	2055911101

Signature of

Role	Plan administrator
Date	2011-01-20
Name of individual signing	M. DALE WILLIAMS

Member

Name	Role
WILLIAMS, M DALE	Member

Events

Event Date	Event Type	Old Value	New Value
2014-08-25	Name Change	M. Dale Williams, D.M.D., P.A.	Benjamin D. Williams, DMD, PA

Date of last update: 30 Jul 2024

Sources: Alabama Secretary of State

Benjamin D. Williams, DMD, PA

Details

National Provider Identifier

form 5500

Member

Events

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