| Name: | Shelby Pediatric Dentistry, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 06 Dec 2013 (11 years ago) |
| Entity Number: | 000-292-837 |
| Register Number: | 000292837 |
| County: | Shelby |
| Place of Formation: | Jefferson County |
| Principal Address: | 123 N LAKE DRIVEBIRMINGHAM, AL 35242 |
| Principal Address ZIP Code: | 35242 |
| Registered Office Street Address: | 2090 COLUMBIANA ROAD SUITE 2000BIRMINGHAM, AL 35216 |
| Registered Office Street Address ZIP Code: | 35216 |
| Authorized Capital: | 1000 @ $1.00 PV |
Activities
DENTISTRY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962813188 | 2014-05-09 | 2014-05-09 | 123 N LAKE DR, BIRMINGHAM, AL, 352427020, US | 2490 PELHAM PARKWAY, PELHAM, AL, 35124, US | |||||||||||||||||
|
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| Phone | +1 205-419-7444 |
Authorized person
| Name | DR. RICHARD TURNER BAXTER |
| Role | OWNER / DENTIST |
| Phone | 2058763989 |
Taxonomy
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| License Number | 5946 |
| State | AL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| HASTY, WILLIAM D JR | Agent | 2090 COLUMBIANA ROAD STE 2000BIRMINGHAM, AL 35216 |
| Name | Role | Address |
|---|---|---|
| BAXTER, RICHARD | Director | 100 AUTUMN PLACEBIRMINGHAM, AL 35242 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
