| Name: | Liles Pediatric Dentistry, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 10 Jun 2010 (14 years ago) |
| Entity Number: | 000-264-449 |
| Register Number: | 000264449 |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Principal Address: | MONTGOMERY, AL |
| Registered Office Street Address: | 2828 EDGEMONT AVEMONTGOMERY, AL 36108 |
| Registered Office Street Address ZIP Code: | 36108 |
| Authorized Capital: | $1,000 |
Activities
PEDIATRIC DENTISTRY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1669793246 | 2010-06-17 | 2010-06-17 | PO BOX 1148, MONTGOMERY, AL, 361011148, US | 2828 W EDGEMONT AVE, MONTGOMERY, AL, 361084020, US | |||||||||||||
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| Phone | +1 205-401-4998 |
Authorized person
| Name | DR. GEORGE BRABNER LILES |
| Role | DENTIST |
| Phone | 2054014998 |
Taxonomy
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LILES PEDIATRIC DENTISTRY 401(K) PLAN | 2023 | 272853800 | 2024-07-30 | LILES PEDIATRIC DENTISTRY, P.C. | 18 | |||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-07-30 |
| Name of individual signing | JOHN ANSAY |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 541990 |
| Sponsor’s telephone number | 3348870099 |
| Plan sponsor’s address | 1204 OGLETREE VILLAGE LANE, AUBURN, AL, 36830 |
Signature of
| Role | Plan administrator |
| Date | 2023-06-12 |
| Name of individual signing | JOHN ANSAY |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 541990 |
| Sponsor’s telephone number | 3348870099 |
| Plan sponsor’s address | 1204 OGLETREE VILLAGE LANE, AUBURN, AL, 36830 |
Signature of
| Role | Plan administrator |
| Date | 2022-06-03 |
| Name of individual signing | JOHN ANSAY |
| File | View Page |
| Three-digit plan number (PN) | 501 |
| Effective date of plan | 2019-03-01 |
| Business code | 524140 |
| Sponsor’s telephone number | 3348870099 |
| Plan sponsor’s address | 2320 MOORES MILL RD STE 250, AUBURN, AL, 36830 |
Plan administrator’s name and address
| Administrator’s EIN | 834125247 |
| Plan administrator’s name | ARSENAL HEALTH LLC |
| Plan administrator’s address | 5151 HAMPSTEAD HIGH STREET, SUITE 200, MONTGOMERY, AL, 36116 |
Signature of
| Role | Plan administrator |
| Date | 2021-10-07 |
| Name of individual signing | THOMAS BRITT TAYLOR |
| Name | Role | Address |
|---|---|---|
| SIMMONS, CHRISTOPHER S | Incorporator | 184 COMMERCE STREETMONTGOMERY, AL 36104 |
| Name | Role | Address |
|---|---|---|
| LILES, GEORGE B | Agent | 1204 OGLETREE VILLAGE LANEAUBURN, AL 36830 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
