| Name: | Larry J. Whisenant, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 03 Jan 1995 (30 years ago) (Companies founded in January 1995) |
| Entity Number: | 000-168-999 |
| Register Number: | 000168999 |
| ZIP code: | 35592 (Companies in Lamar, 35592) |
| County: | Lamar |
| Place of Formation: | Lamar County |
| Principal Address: | VERNON, AL |
| Registered Office Street Address: | 121 10TH STREETVERNON, AL 35592 |
| Authorized Capital: | $5,000 |
| Paid Share Capital: | ---- |
Activities
PRACTICE OF DENTISTRY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396812186 | 2006-11-29 | 2009-09-17 | 121 10TH ST NW, POB 448, VERNON, AL, 355925843, US | 121 10TH ST NW, VERNON, AL, 35592, US | |||||||||||||||||||||||||
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| Phone | +1 205-695-7171 |
| Fax | 2056950801 |
Authorized person
| Name | LARRY JOE WHISENANT |
| Role | OWNER DENTIST |
| Phone | 2056957171 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| License Number | 3713 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529921320 |
| State | AL |
| Name | Role |
|---|---|
| DANIEL J. WHISENANT | Agent |
| Name | Role |
|---|---|
| WHISENANT, LARRY J | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
