| Name: | Crestline Village Dentistry, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Dissolved |
| Date of registration: | 14 May 2002 (23 years ago) |
| Date of dissolution: | 21 Mar 2017 |
| Entity Number: | 000-222-953 |
| Register Number: | 000222953 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | MOUNTAIN BROOK, AL |
| Registered Office Street Address: | 244 COUNTRY CLUB PARKMOUNTAIN BROOK, AL 35213 |
| Registered Office Street Address ZIP Code: | 35213 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $1,000 |
Activities
DENTAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174713895 | 2007-07-30 | 2007-07-30 | 244 COUNTRY CLUB PARK, BIRMINGHAM, AL, 352134200, US | 244 COUNTRY CLUB PARK, BIRMINGHAM, AL, 352134200, US | |||||||||||||||||||||||||
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| Phone | +1 205-870-5700 |
| Fax | 2058705699 |
Authorized person
| Name | GEORGIA C JONES |
| Role | OWNER |
| Phone | 2058705700 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| License Number | 5014 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | ALABAMA DENTAL LICENSE NU |
| Number | 5014 |
| State | AL |
| Name | Role |
|---|---|
| JONES, GEORGIA C | Agent |
| Name | Role |
|---|---|
| JONES, GEORGIA C | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
