| Name: | Shoals Smile By Design, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 13 Mar 2008 (17 years ago) |
| Date of dissolution: | 09 Mar 2021 |
| Entity Number: | 000-256-547 |
| Register Number: | 000256547 |
| County: | Elmore |
| Place of Formation: | Colbert County |
| Principal Address: | MONTGOMERY, AL |
| Registered Office Street Address: | 4037 US 231 STE AWETUMPKA, AL 36093 |
| Registered Office Street Address ZIP Code: | 36093 |
| Authorized Capital: | 1,000 |
Activities
DENTISTRY PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730346321 | 2008-05-21 | 2008-05-21 | PO BOX 3542, MUSCLE SHOALS, AL, 356623542, US | 301 W STATE ST, MUSCLE SHOALS, AL, 356612835, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 256-314-0676 |
| Fax | 2563146373 |
Authorized person
| Name | MRS. ROBBIE L GALLOWAY |
| Role | OFFICE MANAGER |
| Phone | 2563140676 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| License Number | 4664 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | UNITED CONCORDIA |
| Number | 000764070 |
| Issuer | MEDICAID |
| Number | 529903880 |
| State | AL |
| Issuer | BCBS |
| Number | 92836 |
| State | AL |
| Issuer | BCBS |
| Number | 3140572 |
| State | TN |
| Name | Role | Address |
|---|---|---|
| INCORP SERVICES INC | Agent | 3773 HOWARD HUGHES PKWY SUITE 500SLAS VEGAS, NV 89169 |
| Name | Role | Address |
|---|---|---|
| FORM-A-CORP | Incorporator | 4400 PGA BLVD SUITE 900PALM BEACH GARDENS, FL 33410 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
