| Name: | Children's Dentistry of Central Alabama, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 03 Jan 1979 (46 years ago) |
| Entity Number: | 000-056-901 |
| Register Number: | 000056901 |
| Historical Names: |
Donald M. Russell, Jr., M.D., P.C.
|
| Place of Formation: | Dallas County |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $1,000 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1831328004 | 2009-07-09 | 2018-07-23 | 2425 MEDICAL CENTER PKWY, SELMA, AL, 367017756, US | 2425 MEDICAL CENTER PKWY, SELMA, AL, 36701, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 334-875-1330 |
| Fax | 3348756284 |
Authorized person
| Name | DR. JAMES OSBORN |
| Role | OWNER |
| Phone | 3348751330 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 5695 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| License Number | 3063 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000095993 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| RUSSELL, DONALD M JR | Incorporator | 2425 MEDICAL CENTER PARKWAYSELMA, AL 36701 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2011-10-21 | Name Change | Donald M. Russell, Jr., M.D., P.C. | Children's Dentistry of Central Alabama, P.C. |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
