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Medplex Pediatric Dentistry, Inc.

Details

Name: Medplex Pediatric Dentistry, Inc.
Jurisdiction: Alabama
Legal type: Domestic Corporation
Status: Exists
Date of registration: 22 Mar 2004 (21 years ago) (Companies founded in March 2004)
Entity Number: 000-234-338
Register Number: 000234338
ZIP code: 35226 (Companies in Jefferson, 35226)
County: Jefferson
Place of Formation: Jefferson County
Principal Address: BIRMINGHAM, AL
Registered Office Street Address: 700 CENTURY PARK S STE 112BIRMINGHAM, AL 35226
Authorized Capital: $100

Activities GENERAL/PEDIATRIC DENTISTRY PRACTICE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1518078674 2006-08-31 2020-08-22 4515 SOUTHLAKE PKWY, SUITE 200, BIRMINGHAM, AL, 352443317, US 4515 SOUTHLAKE PKWY, SUITE 200, BIRMINGHAM, AL, 352443317, US

Contacts
Phone +1 205-453-0314
Fax 2054530315

Authorized person
Name DR. RICHARD BAKER CHAMBLISS JR.
Role PRESIDENT
Phone 2054530314

Taxonomy
Taxonomy Code 1223P0221X - Pediatric Dentist
License Number 5181
State AL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MEDPLEX PEDIATRIC DENTISTRY, INC. 401(K) PLAN 2021 200904679 2022-10-14 MEDPLEX PEDIATRIC DENTISTRY, INC. 55
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2054530314
Plan sponsor’s address 3000 SOUTHLAKE PARK, SUITE 200, BIRMINGHAM, AL, 35244
MEDPLEX PEDIATRIC DENTISTRY, INC. 401(K) PLAN 2021 200904679 2022-10-15 MEDPLEX PEDIATRIC DENTISTRY, INC. 55
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2054530314
Plan sponsor’s address 3000 SOUTHLAKE PARK, SUITE 200, BIRMINGHAM, AL, 35244
MEDPLEX PEDIATRIC DENTISTRY, INC. 401(K) PLAN 2020 200904679 2021-09-07 MEDPLEX PEDIATRIC DENTISTRY, INC. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2054530314
Plan sponsor’s address 3000 SOUTHLAKE PARK, SUITE 200, BIRMINGHAM, AL, 35244

Signature of
Role Plan administrator
Date 2021-09-07
Name of individual signing DAVID BOYD
MEDPLEX PEDIATRIC DENTISTRY, INC. 401(K) PLAN 2019 200904679 2020-10-14 MEDPLEX PEDIATRIC DENTISTRY, INC. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2054530314
Plan sponsor’s address 3000 SOUTHLAKE PARK, SUITE 200, BIRMINGHAM, AL, 35244

Signature of
Role Plan administrator
Date 2020-10-14
Name of individual signing BAKER CHAMBLISS
MEDPLEX PEDIATRIC DENTISTRY, INC. 401(K) PLAN 2018 200904679 2019-05-30 MEDPLEX PEDIATRIC DENTISTRY, INC. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2054530314
Plan sponsor’s address 3000 SOUTHLAKE PARK, SUITE 200, BIRMINGHAM, AL, 35244

Signature of
Role Plan administrator
Date 2019-05-25
Name of individual signing R.BAKER CHAMBLISS
Role Employer/plan sponsor
Date 2019-05-25
Name of individual signing R BAKER CHAMBLISS
MEDPLEX PEDIATRIC DENTISTRY, INC. 401(K) PLAN 2017 200904679 2018-10-10 MEDPLEX PEDIATRIC DENTISTRY, INC. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2054530314
Plan sponsor’s address 3000 SOUTHLAKE PARK, SUITE 200, BIRMINGHAM, AL, 35244

Signature of
Role Plan administrator
Date 2018-10-10
Name of individual signing R.BAKER CHAMBLISS
Role Employer/plan sponsor
Date 2018-10-10
Name of individual signing R BAKER CHAMBLISS
MEDPLEX PEDIATRIC DENTISTRY, INC. 401(K) PLAN 2016 200904679 2017-10-04 MEDPLEX PEDIATRIC DENTISTRY, INC. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2054530314
Plan sponsor’s address 3000 SOUTHLAKE PARK, SUITE 200, BIRMINGHAM, AL, 35244

Signature of
Role Plan administrator
Date 2017-10-03
Name of individual signing R.BAKER CHAMBLISS
Role Employer/plan sponsor
Date 2017-10-03
Name of individual signing R BAKER CHAMBLISS
MEDPLEX PEDIATRIC DENTISTRY, INC. 401(K) PLAN 2015 200904679 2016-09-27 MEDPLEX PEDIATRIC DENTISTRY, INC. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2054530314
Plan sponsor’s address 3000 SOUTHLAKE PARK, SUITE 200, BIRMINGHAM, AL, 35244

Signature of
Role Plan administrator
Date 2016-09-27
Name of individual signing R.BAKER CHAMBLISS
Role Employer/plan sponsor
Date 2016-09-27
Name of individual signing R BAKER CHAMBLISS
MEDPLEX PEDIATRIC DENTISTRY, INC. 401(K) PLAN 2014 200904679 2015-09-29 MEDPLEX PEDIATRIC DENTISTRY, INC. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2054530314
Plan sponsor’s address 3000 SOUTHLAKE PARK, SUITE 200, BIRMINGHAM, AL, 35244

Signature of
Role Plan administrator
Date 2015-09-29
Name of individual signing R.BAKER CHAMBLISS
Role Employer/plan sponsor
Date 2015-09-29
Name of individual signing R BAKER CHAMBLISS
MEDPLEX PEDIATRIC DENTISTRY, INC. 401(K) PLAN 2013 200904679 2014-09-23 MEDPLEX PEDIATRIC DENTISTRY, INC. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2054530314
Plan sponsor’s address 3000 SOUTHLAKE PARK, SUITE 200, BIRMINGHAM, AL, 35244

Signature of
Role Plan administrator
Date 2014-09-23
Name of individual signing R.BAKER CHAMBLISS
Role Employer/plan sponsor
Date 2014-09-23
Name of individual signing R BAKER CHAMBLISS

Agent

Name Role
WYLIE, C HEATHER Agent

Incorporator

Name Role
CHAMBLISS, R BAKER JR Incorporator

Related by officers

No related officers

Related by address

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Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State

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