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North Jackson Dental Care, P.C.

Details

Name: North Jackson Dental Care, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 12 Dec 1997 (27 years ago) (Companies founded in December 1997)
Entity Number: 000-191-931
Register Number: 000191931
ZIP code: 35772 (Companies in Jackson, 35772)
County: Jackson
Place of Formation: Jackson County
Principal Address: STEVENSON, AL
Registered Office Street Address: 105 ADAMS STREETSTEVENSON, AL 35772
Authorized Capital: 1,000

Activities DENTAL SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1659456879 2006-10-26 2020-08-22 105 ADAMS STREET, STEVENSON, AL, 35772, US 105 ADAMS STREET, STEVENSON, AL, 35772, US

Contacts

Phone +1 256-437-2191
Fax 2564371066

Authorized person

Name DR. STEPHEN SCOTT SHEPHERD
Role DR PRESIDENT OF CORPORATION
Phone 2564372191

Taxonomy

Taxonomy Code 122300000X - Dentist
License Number 3796
State AL
Is Primary Yes

Other Provider Identifiers

Issuer BLUE CROSS BLUE SHIELD
Number 3093026
State TN
Issuer UNITED CONCORDIA
Number 595965

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
NORTH JACKSON DENTAL CARE, P.C. PROFIT SHARING PLAN 2011 631189507 2012-05-23 NORTH JACKSON DENTAL CARE, P.C. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621210
Plan sponsor’s address 105 ADAMS STREET, STEVENSON, AL, 35772

Plan administrator’s name and address

Administrator’s EIN 631189507
Plan administrator’s name NORTH JACKSON DENTAL CARE, P.C.
Plan administrator’s address 105 ADAMS STREET, STEVENSON, AL, 35772
Administrator’s telephone number 2564372191

Signature of

Role Plan administrator
Date 2012-05-23
Name of individual signing SCOTT SHEPHERD, D.M.D.
NORTH JACKSON DENTAL CARE, P.C. PROFIT SHARING PLAN 2010 631189507 2011-07-12 NORTH JACKSON DENTAL CARE, P.C. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621210
Sponsor’s telephone number 2564372191
Plan sponsor’s address 105 ADAMS STREET, STEVENSON, AL, 35772

Plan administrator’s name and address

Administrator’s EIN 631189507
Plan administrator’s name NORTH JACKSON DENTAL CARE, P.C.
Plan administrator’s address 105 ADAMS STREET, STEVENSON, AL, 35772
Administrator’s telephone number 2564372191

Signature of

Role Plan administrator
Date 2011-07-12
Name of individual signing SCOTT SHEPHERD, D.M.D.
NORTH JACKSON DENTAL CARE, P.C. PROFIT SHARING PLAN 2009 631189507 2010-07-14 NORTH JACKSON DENTAL CARE, P.C. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621210
Sponsor’s telephone number 2564372191
Plan sponsor’s address 105 ADAMS STREET, STEVENSON, AL, 35772

Plan administrator’s name and address

Administrator’s EIN 631189507
Plan administrator’s name NORTH JACKSON DENTAL CARE, P.C.
Plan administrator’s address 105 ADAMS STREET, STEVENSON, AL, 35772
Administrator’s telephone number 2564372191

Signature of

Role Plan administrator
Date 2010-07-14
Name of individual signing SCOTT SHEPHERD, D.M.D.
Role Employer/plan sponsor
Date 2010-07-14
Name of individual signing SCOTT SHEPHERD, D.M.D.

Agent

Name Role Address
SHEPHERD, SCOTT Agent 6302 37TH CT NETUSCALOOSA, AL 35406

Incorporator

Name Role Address
SHEPHERD, SCOTT Incorporator 6302 37TH CT NETUSCALOOSA, AL 35406

Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State