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Marvin M. Hewlett, Jr., D.D.S., P.C.

Details

Name: Marvin M. Hewlett, Jr., D.D.S., P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Dissolved
Date of registration: 02 Jan 2004 (21 years ago)
Date of dissolution: 19 Dec 2019
Entity Number: 000-232-619
Register Number: 000232619
County: Butler
Place of Formation: Butler County
Principal Address: GREENVILLE, AL
Registered Office Street Address: 402 E COMMERCE STGREENVILLE, AL 36037
Registered Office Street Address ZIP Code: 36037
Authorized Capital: 200 NPV

Activities DENTAL SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1790895530 2006-08-30 2016-05-03 402 E COMMERCE STREET, GREENVILLE, AL, 36037, US 402 E COMMERCE STREET, GREENVILLE, AL, 36037, US

Contacts

Phone +1 334-382-5431
Fax 3343822492

Authorized person

Name DR. MARVIN MCCOY HEWLETT JR.
Role DENTIST PRESIDENT
Phone 3343825431

Taxonomy

Taxonomy Code 122300000X - Dentist
License Number 3171
State AL
Is Primary Yes

Other Provider Identifiers

Issuer BLUE CROSS BLUE SHIELD AL
Number 515 20247
State AL
Issuer MEDICAID
Number 529919350
State AL

Agent

Name Role
HEWLETT, MARVIN M JR Agent

Incorporator

Name Role
HEWLETT, MARVIN M JR Incorporator

Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State