| Name: | NORTH SHELBY DENTAL STUDIO, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 27 Jan 2014 (11 years ago) |
| Entity Number: | 000-296-365 |
| Register Number: | 000296365 |
| County: | Shelby |
| Place of Formation: | Shelby County |
| Registered Office Street Address: | 378 OXFORD WAYPELHAM, AL 35124 |
| Registered Office Street Address ZIP Code: | 35124 |
Activities
PRACTICE OF DENTISTRY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184036154 | 2014-05-27 | 2014-05-27 | 2000 SOUTHLAKE PARK, SUITE 250, HOOVER, AL, 352443616, US | 2000 SOUTHLAKE PARK, SUITE 250, HOOVER, AL, 352443616, US | |||||||||||||||||||||||
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| Phone | +1 205-278-3316 |
Authorized person
| Name | DR. DAVID W COWAN |
| Role | OWNER/DENTIST |
| Phone | 2052783316 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 4292 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51091025 |
| State | AL |
| Name | Role |
|---|---|
| COWAN, DAVID W | Agent |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
