| Name: | Center for Cosmetic and Restorative Dentistry, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 11 Jul 2001 (23 years ago) |
| Entity Number: | 000-217-691 |
| Register Number: | 000217691 |
| County: | Tuscaloosa |
| Place of Formation: | Tuscaloosa County |
| Principal Address: | NORTHPORT, AL |
| Registered Office Street Address: | 2820 LURLEEN WALLACE BLVDNORTHPORT, AL 35476 |
| Registered Office Street Address ZIP Code: | 35476 |
| Authorized Capital: | $5,000 |
Activities
PRACTICE DENTISTRY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1932354727 | 2008-11-21 | 2008-11-21 | 2820 LURLEEN B WALLACE BLVD, NORTHPORT, AL, 354763249, US | 2820 LURLEEN B WALLACE BLVD, NORTHPORT, AL, 354763249, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-339-6762 |
| Fax | 2053399103 |
Authorized person
| Name | MRS. MARY KAY CARVER |
| Role | FINANCIAL COORDINATOR |
| Phone | 2053396762 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 4859 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 5007 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 5240 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 5467 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | INDIVIDUAL NPI |
| Number | 1023199213 |
| State | AL |
| Issuer | INDIVIDUAL NPI |
| Number | 1972679967 |
| State | AL |
| Issuer | INDIVIDUAL NPI |
| Number | 1356425649 |
| State | AL |
| Issuer | INDIVIDUAL NPI |
| Number | 1851475149 |
| State | AL |
| Name | Role |
|---|---|
| DAVIS, ROBERT H | Agent |
| Name | Role |
|---|---|
| DAVID, ROBERT H | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
