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Bivona Family Dental LLC

Details

Name: Bivona Family Dental LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 30 Aug 2012 (12 years ago) (Companies founded in August 2012)
Entity Number: 000-266-786
Register Number: 000266786
ZIP code: 35501 (Companies in Walker, 35501)
County: Walker
Place of Formation: Walker County
Registered Office Street Address: 1208 HIGHWAY 78 EASTJASPER, AL 35501

Activities DENTISTRY

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1285988758 2012-11-05 2012-11-05 1206 HIGHWAY 78 E, JASPER, AL, 355013939, US 1206 HIGHWAY 78 E, JASPER, AL, 355013939, US

Contacts
Phone +1 205-387-8888
Fax 2053878118

Authorized person
Name DR. MICHAEL JACOB BIVONA
Role DENTIST
Phone 2053878888

Taxonomy
Taxonomy Code 122300000X - Dentist
License Number 5848
State AL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 142151
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BIVONA FAMILY DENTAL RETIREMENT PLAN & TRUST 2023 460873341 2024-03-20 BIVONA FAMILY DENTAL LLC 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-01-01
Business code 621210
Sponsor’s telephone number 2052212733
Plan sponsor’s address 1208 HIGHWAY 78 EAST, JASPER, AL, 35501
BIVONA FAMILY DENTAL RETIREMENT PLAN & TRUST 2022 460873341 2023-05-10 BIVONA FAMILY DENTAL LLC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-01-01
Business code 621210
Sponsor’s telephone number 2052212733
Plan sponsor’s address 1208 HIGHWAY 78 EAST, JASPER, AL, 35501
BIVONA FAMILY DENTAL RETIREMENT PLAN & TRUST 2021 460873341 2022-05-12 BIVONA FAMILY DENTAL LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-01-01
Business code 621210
Sponsor’s telephone number 2052212733
Plan sponsor’s address 1208 HIGHWAY 78 EAST, JASPER, AL, 35501
BIVONA FAMILY DENTAL RETIREMENT PLAN & TRUST 2020 460873341 2021-08-16 BIVONA FAMILY DENTAL LLC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-01-01
Business code 621210
Sponsor’s telephone number 2052212733
Plan sponsor’s address 1208 HIGHWAY 78 EAST, JASPER, AL, 35501
BIVONA FAMILY DENTAL RETIREMENT PLAN & TRUST 2019 460873341 2020-08-17 BIVONA FAMILY DENTAL LLC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-01-01
Business code 621210
Sponsor’s telephone number 2052212733
Plan sponsor’s address 1208 HIGHWAY 78 EAST, JASPER, AL, 35501
BIVONA FAMILY DENTAL RETIREMENT PLAN & TRUST 2018 460873341 2019-04-22 BIVONA FAMILY DENTAL LLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-01-01
Business code 621210
Sponsor’s telephone number 2052212733
Plan sponsor’s address 1208 HIGHWAY 78 EAST, JASPER, AL, 35501

Agent

Name Role Address
BIVONA, JACOB Agent 1208 HWY 78 EASTJASPER, AL 35501

Organizer

Name Role Address
BIVONA, JACOB Organizer 1208 HWY 78 EASTJASPER, AL 35501
FULMER, TIMOTHY M Organizer 4 OFFICE PARK CIRCLE STE 215BIRMINGHAM, AL 35223

Related by officers

FULMER, TIMOTHY M

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Related by address

No related companies by address

Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State

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