| Name: | Fresh Wave Dental Care, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 06 May 1999 (26 years ago) (Companies founded in May 1999) |
| Entity Number: | 000-202-593 |
| Register Number: | 000202593 |
| ZIP code: | 36330 (Companies in Coffee, 36330) |
| County: | Coffee |
| Place of Formation: | Coffee County |
| Principal Address: | ENTERPRISE, AL |
| Registered Office Street Address: | 812 BOLL WEEVIL CIRCLEENTERPRISE, AL 36330 |
| Authorized Capital: | $100 |
| Paid Share Capital: | $100 |
Activities
PROVIDE DENTAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134392517 | 2008-04-08 | 2008-04-08 | 812 BOLL WEEVIL CIR, ENTERPRISE, AL, 363302079, US | 812 BOLL WEEVIL CIR, ENTERPRISE, AL, 363302079, US | |||||||||||||||||||||||
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| Phone | +1 334-347-9283 |
Authorized person
| Name | MRS. DEBBIELEE J HAWN |
| Role | OFFICE MANGER |
| Phone | 3343479283 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| License Number | 4810 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51027316 |
| State | AL |
| Name | Role |
|---|---|
| NICHOLS, RUSSELL D JR | Agent |
| Name | Role |
|---|---|
| NICHOLS, RUSSELL D JR | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
