| Name: | Decatur Family Dentistry, PC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 08 May 2002 (23 years ago) |
| Entity Number: | 000-222-837 |
| Register Number: | 000222837 |
| County: | Morgan |
| Place of Formation: | Morgan County |
| Principal Address: | DECATUR, AL |
| Registered Office Street Address: | 2422 DANVILLE RD SW STE HDECATUR, AL 35603 |
| Registered Office Street Address ZIP Code: | 35603 |
| Authorized Capital: | $1,000 |
Activities
DENTAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073608477 | 2006-10-03 | 2010-02-18 | 2426 DANVILLE ROAD SW, SUITE R, DECATUR, AL, 35603, US | 2426 DANVILLE ROAD SW, SUITE R, DECATUR, AL, 35603, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 256-355-1557 |
| Fax | 2563551911 |
Authorized person
| Name | DR. ALICIA JOHNSON NAILS |
| Role | DENTIST/OWNER |
| Phone | 2563551557 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 5021 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | UNITED CONCORDIA PROV. # |
| Number | 1375438 |
| State | AL |
| Issuer | BCBS OF AL PROV. # |
| Number | 51507837NAI |
| State | AL |
| Name | Role |
|---|---|
| NAILS, ALICIA JOHNSON | Agent |
| Name | Role |
|---|---|
| NAILS, ALICIA JOHNSON | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
