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Robert B. Embry, DDS, P.C.

Details

Name: Robert B. Embry, DDS, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 02 Apr 2003 (22 years ago)
Entity Number: 000-228-371
Register Number: 000228371
County: Lauderdale
Place of Formation: Lauderdale County
Principal Address: FLORENCE, AL
Registered Office Street Address: 2009 DARBY DRFLORENCE, AL 35630
Registered Office Street Address ZIP Code: 35630
Authorized Capital: $1,000

Activities DEAL IN PROPERTY

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1508957283 2006-09-27 2014-09-23 642 COX CREEK PARKWAY, FLORENCE, AL, 35630, US 642 COX CREEK PARKWAY, FLORENCE, AL, 35630, US

Contacts

Phone +1 256-760-5696
Fax 2567600599

Authorized person

Name ROBERT B EMBRY
Role OWNER
Phone 2567605696

Taxonomy

Taxonomy Code 122300000X - Dentist
License Number 5158
State AL
Is Primary Yes
Taxonomy Code 122300000X - Dentist
License Number DS0000007514
State TN
Is Primary No

Other Provider Identifiers

Issuer MEDICAID
Number 009918845
State AL

Incorporator

Name Role
LENTS, ROBIN Incorporator
EMBRY, ROBERT B Incorporator

Agent

Name Role Address
NORVELL, CARTER C Agent 2009 DARBY DRIVEFLORENCE, AL 35630

Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State