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Trussville Pediatric Dentistry, P.C.

Details

Name: Trussville Pediatric Dentistry, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Dissolved
Date of registration: 13 Jan 2006 (19 years ago) (Companies founded in January 2006)
Date of dissolution: 22 Jan 2024
Entity Number: 000-245-283
Register Number: 000245283
ZIP code: 35203 (Companies in Jefferson, 35203)
County: Jefferson
Place of Formation: Jefferson County
Registered Office Street Address: 420 TWENTIETH ST NORTHBIRMINGHAM, AL 35203
Authorized Capital: $1,000

Activities DENTISTRY PRACTICE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1801077334 2007-11-27 2009-11-19 123 N CHALKVILLE RD, STE 1, TRUSSVILLE, AL, 351731376, US 123 N CHALKVILLE RD, STE 1, TRUSSVILLE, AL, 351731376, US

Contacts
Phone +1 205-655-1000
Fax 2056557196

Authorized person
Name DR. THOMAS G WILLINGHAM
Role OWNER
Phone 2056551000

Taxonomy
Taxonomy Code 1223P0221X - Pediatric Dentist
License Number 5379
State AL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 559929290
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TRUSSVILLE PEDIATRIC DENTISTRY 401K PLAN 2021 204160011 2022-10-10 TRUSSVILLE PEDIATRIC DENTISTRY 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 2056551000
Plan sponsor’s address 4901 DEERFOOT PARKWAY, SUITE 101, TRUSSVILLE, AL, 35173
TRUSSVILLE PEDIATRIC DENTISTRY 401K PLAN 2020 204160011 2021-08-26 TRUSSVILLE PEDIATRIC DENTISTRY 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 2056551000
Plan sponsor’s address 4901 DEERFOOT PARKWAY, SUITE 101, TRUSSVILLE, AL, 35173
TRUSSVILLE PEDIATRIC DENTISTRY 401K PLAN 2019 204160011 2020-10-14 TRUSSVILLE PEDIATRIC DENTISTRY 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 2056551000
Plan sponsor’s address 4901 DEERFOOT PKWY, SUITE 101, TRUSSVILLE, AL, 35173

Signature of
Role Plan administrator
Date 2020-10-14
Name of individual signing THOMAS WILLINGHAM
TRUSSVILLE PEDIATRIC DENTISTRY 401K PLAN 2018 204160011 2019-04-22 TRUSSVILLE PEDIATRIC DENTISTRY 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 2056551000
Plan sponsor’s address 123 NORTH CHALKVILLE RD., TRUSSVILLE, AL, 35173

Signature of
Role Plan administrator
Date 2019-04-22
Name of individual signing THOMAS WILLINGHAM
TRUSSVILLE PEDIATRIC DENTISTRY 401K PLAN 2017 204160011 2018-07-18 TRUSSVILLE PEDIATRIC DENTISTRY 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 2056551000
Plan sponsor’s address 123 NORTH CHALKVILLE RD., TRUSSVILLE, AL, 35173

Signature of
Role Plan administrator
Date 2018-07-18
Name of individual signing THOMAS WILLINGHAM
TRUSSVILLE PEDIATRIC DENTISTRY 401K PLAN 2016 204160011 2017-08-07 TRUSSVILLE PEDIATRIC DENTISTRY 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 2056551000
Plan sponsor’s address 123 NORTH CHALKVILLE RD., TRUSSVILLE, AL, 35173

Signature of
Role Plan administrator
Date 2017-08-07
Name of individual signing THOMAS WILLINGHAM
TRUSSVILLE PEDIATRIC DENTISTRY 401K PLAN 2015 204160011 2016-07-26 TRUSSVILLE PEDIATRIC DENTISTRY 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 2056551000
Plan sponsor’s address 123 NORTH CHALKVILLE RD., TRUSSVILLE, AL, 35173
TRUSSVILLE PEDIATRIC DENTISTRY 401K PLAN 2014 204160011 2015-07-24 TRUSSVILLE PEDIATRIC DENTISTRY 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 812990
Sponsor’s telephone number 2056551000
Plan sponsor’s address 123 NORTH CHALKVILLE RD., TRUSSVILLE, AL, 35173

Signature of
Role Plan administrator
Date 2015-07-24
Name of individual signing THOMAS GLENN WILLINGHAM
TRUSSVILLE PEDIATRIC DENTISTRY 401K PLAN 2013 204160011 2014-09-30 TRUSSVILLE PEDIATRIC DENTISTRY 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 812990
Sponsor’s telephone number 2052987462
Plan sponsor’s address 123 NORTH CHALKVILLE RD., TRUSSVILLE, AL, 35773

Signature of
Role Plan administrator
Date 2014-09-30
Name of individual signing THOMAS GLENN WILLINGHAM
TRUSSVILLE PEDIATRIC DENTISTRY 401K PLAN 2012 204160011 2013-07-10 TRUSSVILLE PEDIATRIC DENTISTRY 7
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 812990
Sponsor’s telephone number 2052987462
Plan sponsor’s address 123 NORTH CHALKVILLE RD., TRUSSVILLE, AL, 35773

Signature of
Role Plan administrator
Date 2013-07-10
Name of individual signing THOMAS GLENN WILLINGHAM

Agent

Name Role Address
POST, CHAD J Agent 361 SUMMIT BLVD SUITE 110BIRMINGHAM, AL 35243

Incorporator

Name Role Address
POST, CHAD J Incorporator 361 SUMMIT BLVD SUITE 110BIRMINGHAM, AL 35243

Related by officers

POST, CHAD J

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Related by address

420 TWENTIETH ST NORTHBIRMINGHAM, AL 35203

R. Matt Stephenson DMD, P.C. Project Corporate Leadership, Inc.

Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State

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