| Name: | South Alabama Pediatric Dentistry, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 30 Dec 2013 (11 years ago) |
| Entity Number: | 000-293-976 |
| Register Number: | 000293976 |
| County: | Mobile |
| Place of Formation: | Mobile County |
| Registered Office Street Address: | 801 UNIVERSITY BOULEVARDMOBILE, AL 36609 |
| Registered Office Street Address ZIP Code: | 36609 |
Activities
GENERAL/PEDIATRIC DENTAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1437289303 | 2007-03-07 | 2013-12-31 | 801 UNIVERSITY BLVD S, STE B, MOBILE, AL, 366092923, US | 801 UNIVERSITY BLVD S, STE B, MOBILE, AL, 366092923, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 251-345-1717 |
| Fax | 2513430835 |
Authorized person
| Name | DR. EARL GAINES THOMAS |
| Role | OWNER |
| Phone | 2513451717 |
Taxonomy
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| License Number | 3282 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529912670 |
| State | AL |
| Name | Role |
|---|---|
| THOMAS, E G | Agent |
| Name | Role | Address |
|---|---|---|
| SHARP, THOMAS E III | Organizer | 11 NORTH WATER STREET, SUITE 24290MOBILE, AL 36602 |
| THOMAS, E GAINES | Organizer | 801 UNIVERSITY BOULEVARDMOBILE, AL 36609 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
