| Name: | Mark E. Love, D.M.D., P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 17 Dec 1993 (31 years ago) |
| Entity Number: | 000-160-986 |
| Register Number: | 000160986 |
| Historical Names: |
Mark E. Love, DMD, PC
Fieldstown Dental Care, P.C. |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | GARDENDALE, AL |
| Registered Office Street Address: | 1038 MOUNT OLIVE ROADGARDENDALE, AL 35071 |
| Registered Office Street Address ZIP Code: | 35071 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | ---- |
Activities
PRACTICE THE PROFESSION OF DENTISTRY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063928653 | 2017-12-19 | 2017-12-19 | 510 ENGLE DR SE, RUSSELLVILLE, AL, 356532749, US | 510 ENGLE DR SE, RUSSELLVILLE, AL, 356532749, US | |||||||||||||||||||||||||
|
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| Phone | +1 256-332-6073 |
| Fax | 2563326655 |
Authorized person
| Name | DR. MARK EDWIN LOVE |
| Role | DENTIST |
| Phone | 2563326073 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| License Number | 3951 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 63-11104550 |
| State | AL |
| Name | Role |
|---|---|
| LOVE, MARK E DMD | Agent |
| Name | Role |
|---|---|
| LOVE, MARK E DMD | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2007-06-05 | Name Change | Fieldstown Dental Care, P.C. | Mark E. Love, D.M.D., P.C. |
| 1999-07-26 | Name Change | Mark E. Love, DMD, PC | Fieldstown Dental Care, P.C. |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
