| Name: | Midfield Dental Center Associates, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 29 Dec 1993 (31 years ago) |
| Entity Number: | 000-160-920 |
| Register Number: | 000160920 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | MIDFIELD, AL |
| Registered Office Street Address: | 114 EAST BROOKWOOD ROADMIDFIELD, AL 35228 |
| Registered Office Street Address ZIP Code: | 35228 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $1,000 |
Activities
PRACTICE OF DENTISTRY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558436485 | 2006-11-24 | 2020-08-22 | 114 E BROOKWOOD ROAD, MIDFIELD, AL, 35228, US | 114 E BROOKWOOD ROAD, MIDFIELD, AL, 35228, US | |||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 205-923-6828 |
Authorized person
| Name | DR. WILLIAM JEFFERSON GRAVES |
| Role | PRESIDENT |
| Phone | 2059236828 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| License Number | 3419 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 1223P0300X - Periodontist |
| License Number | 2563 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 1223S0112X - Oral and Maxillofacial Surgery (Dentist) |
| License Number | 3460 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | UNITED CONCORDIA |
| Number | 993983 |
| State | PA |
| Name | Role |
|---|---|
| HUGHES, JAMES R | Agent |
| Name | Role |
|---|---|
| HUGHES, JAMES R | Incorporator |
| GRAVES, WILLIAM JEFFERSON | Incorporator |
| JACOBS, WILLIAM PARKS | Incorporator |
| CAMPBELL, WILLIAM L | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
