| Name: | Montgomery Smiles Youth Dentistry, PC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 06 Dec 2006 (18 years ago) (Companies founded in December 2006) |
| Date of dissolution: | 10 Apr 2015 |
| Entity Number: | 000-250-126 |
| Register Number: | 000250126 |
| Historical Names: |
Robert F. Andrus, D.D.S., P.C.
Small Smiles of Montgomery, P.C. |
| ZIP code: | 36104 (Companies in Montgomery, 36104) |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Registered Office Street Address: | 2 NORTH JACKSON STREET SUITE 605MONTGOMERY, AL 36104 |
| Authorized Capital: | $10 |
Activities
DENTAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740351758 | 2006-11-13 | 2014-07-09 | 16 ARCADE UNIT 198747, NASHVILLE, TN, 372191994, US | 3439 MCGEHEE RD, SUITE B, MONTGOMERY, AL, 361113392, US | |||||||||||||||||||||||||
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| Phone | +1 615-750-0343 |
| Fax | 6159861705 |
| Phone | +1 334-228-1868 |
| Fax | 3342881825 |
Authorized person
| Name | MRS. JENELL STUMP |
| Role | MANAGER, LICENSING & CREDENTIALING |
| Phone | 6157500343 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529930610 |
| State | AL |
| Name | Role |
|---|---|
| NATIONAL REGISTERED AGENTS INC | Agent |
| Name | Role |
|---|---|
| KRUGMAN, NEIL B | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2013-12-02 | Name Change | Small Smiles of Montgomery, P.C. | Montgomery Smiles Youth Dentistry, PC |
| 2008-09-30 | Name Change | Robert F. Andrus, D.D.S., P.C. | Small Smiles of Montgomery, P.C. |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
