| Name: | S.M. Mahan, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 02 Apr 2012 (13 years ago) (Companies founded in April 2012) |
| Date of dissolution: | 13 Aug 2021 |
| Entity Number: | 000-048-543 |
| Register Number: | 000048543 |
| Place of Formation: | Bibb County |
Activities
DENTAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336314160 | 2008-04-23 | 2012-04-25 | PO BOX 100, BRIERFIELD, AL, 350350100, US | 19330 HIGHWAY 139, BRIERFIELD, AL, 350353658, US | |||||||||||||||||||||||||
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| Phone | +1 205-665-2723 |
| Fax | 2056651037 |
Authorized person
| Name | DR. STANLEY MICHAEL MAHAN JR. |
| Role | DENTIST/OWNER |
| Phone | 2056652723 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 2722 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529919020 |
| State | AL |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
