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Knollwood Dental Group, P.C.

Details

Name: Knollwood Dental Group, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Dissolved
Date of registration: 05 Jun 1990 (34 years ago)
Date of dissolution: 12 Aug 2015
Entity Number: 000-137-505
Register Number: 000137505
Place of Formation: Mobile County
Principal Address: MOBILE, AL
Registered Office Street Address: 5612 COTTAGE HILL ROADMOBILE, AL
Authorized Capital: $1,000

Activities DENTAL PROFESSION

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1245407436 2008-05-15 2008-05-15 5612 COTTAGE HILL RD, MOBILE, AL, 366094211, US 5612 COTTAGE HILL RD, MOBILE, AL, 366094211, US

Contacts
Phone +1 251-666-3982

Authorized person
Name KATIE MARSHALL
Role OFFICE MANAGER
Phone 2516663982

Taxonomy
Taxonomy Code 261QD0000X - Dental Clinic/Center
License Number 3028
State AL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
KNOLLWOOD DENTAL CAFETERIA PLAN 2011 631026168 2012-09-28 KNOLLWOOD DENTAL GROUP 4
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 2516663982
Plan sponsor’s mailing address 5612 COTTAGE HILL RD, MOBILE, AL, 36609
Plan sponsor’s address 5612 COTTAGE HILL RD, MOBILE, AL, 36609

Plan administrator’s name and address
Administrator’s EIN 631026168
Plan administrator’s name KNOLLWOOD DENTAL GROUP
Plan administrator’s address 5612 COTTAGE HILL RD, MOBILE, AL, 36609
Administrator’s telephone number 2516663982

Number of participants as of the end of the plan year
Active participants 0

Signature of
Role Plan administrator
Date 2012-09-27
Name of individual signing DONALD BROWN
Valid signature Filed with authorized/valid electronic signature
KNOLLWOOD DENTAL CAFETERIA PLAN 2010 631026168 2011-07-26 KNOLLWOOD DENTAL GROUP 5
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2516663982
Plan sponsor’s mailing address 5612 COTTAGE HILL RD, MOBILE, AL, 36609
Plan sponsor’s address 5612 COTTAGE HILL RD, MOBILE, AL, 36609

Plan administrator’s name and address
Administrator’s EIN 631026168
Plan administrator’s name KNOLLWOOD DENTAL GROUP
Plan administrator’s address 5612 COTTAGE HILL RD, MOBILE, AL, 36609
Administrator’s telephone number 2516663982

Number of participants as of the end of the plan year
Active participants 4

Signature of
Role Plan administrator
Date 2011-07-26
Name of individual signing DONALD BROWN
Valid signature Filed with authorized/valid electronic signature
KNOLLWOOD DENTAL CAFETERIA PLAN 2010 631026168 2011-07-19 KNOLLWOOD DENTAL GROUP 5
Three-digit plan number (PN) 501
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2516663982
Plan sponsor’s mailing address 5612 COTTAGE HILL RD, MOBILE, AL, 36609
Plan sponsor’s address 5612 COTTAGE HILL RD, MOBILE, AL, 36609

Plan administrator’s name and address
Administrator’s EIN 631026168
Plan administrator’s name KNOLLWOOD DENTAL GROUP
Plan administrator’s address 5612 COTTAGE HILL RD, MOBILE, AL, 36609
Administrator’s telephone number 2516663982

Number of participants as of the end of the plan year
Active participants 4

Signature of
Role Employer/plan sponsor
Date 2011-07-19
Name of individual signing DONALD BROWN
Valid signature Filed with authorized/valid electronic signature
KNOLLWOOD DENTAL GROUP CAFETERIA PLAN 2009 631026168 2012-09-28 KNOLLWOOD DENTAL GROUP 4
File View Page
Three-digit plan number (PN) 320
Effective date of plan 2001-01-01
Business code 621111
Plan sponsor’s mailing address 5612 COTTAGE HILL RD, MOBILE, AL, 36609
Plan sponsor’s address 5612 COTTAGE HILL RD, MOBILE, AL, 36609

Plan administrator’s name and address
Administrator’s EIN 631026168
Plan administrator’s name KNOLLWOOD DENTAL GROUP
Plan administrator’s address 5612 COTTAGE HILL RD, MOBILE, AL, 36609

Number of participants as of the end of the plan year
Active participants 0

Signature of
Role Plan administrator
Date 2012-09-27
Name of individual signing DONALD BROWN
Valid signature Filed with authorized/valid electronic signature
KNOLLWOOD DENTA GROUP CAFETERIA PLAN 2009 631026168 2010-07-29 KNOLLWOOD DENTAL GROUP 4
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2516663982
Plan sponsor’s mailing address 5612 COTTAGE HILL RD, MOBILE, AL, 36609
Plan sponsor’s address 5612 COTTAGE HILL RD, MOBILE, AL, 36609

Plan administrator’s name and address
Administrator’s EIN 631026168
Plan administrator’s name KNOLLWOOD DENTAL GROUP
Plan administrator’s address 5612 COTTAGE HILL RD, MOBILE, AL, 36609
Administrator’s telephone number 2516663982

Number of participants as of the end of the plan year
Active participants 5

Signature of
Role Plan administrator
Date 2010-07-29
Name of individual signing DONALD BROWN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
BROWN, DONALD E JR Agent

Incorporator

Name Role
BROWN, DONALD E JR Incorporator

Related by officers

BROWN, DONALD E JR

Brown & Brown Enterprises, L.L.C.

Related by address

MOBILE, AL

A-1 Fence-Craft of America, Inc. AAA Air & Hydraulics of Mobile, Inc. AAA Furniture Warehouse Co., Inc. Bradco, Inc. AAP Distributors, Inc. ABC Comfort, Inc. A B C Fence Industries, Inc. A-C Contracting Company, Inc. AEU Claims, Inc. A G R Co., Incorporated

Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

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