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Wortham Dental LLC

Details

Name: Wortham Dental LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 03 Apr 2014 (11 years ago) (Companies founded in April 2014)
Entity Number: 000-306-602
Register Number: 000306602
ZIP code: 35209 (Companies in Jefferson, 35209)
County: Jefferson
Place of Formation: Jefferson County
Principal Address: 1856 LANCASTER ROADHOMEWOOD, AL 35209

Activities PROFESSIONAL AND ANCILLARY DENTAL HEALTH CARE SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1407276041 2014-04-22 2014-04-22 1856 LANCASTER RD, HOMEWOOD, AL, 352094114, US 1856 LANCASTER RD, HOMEWOOD, AL, 352094114, US

Contacts
Phone +1 205-871-2591

Authorized person
Name DR. BENJAMIN WORTHAM
Role DENTIST
Phone 2058712591

Taxonomy
Taxonomy Code 1223G0001X - General Practice Dentistry
License Number 6035
State AL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
WORTHAM DENTAL 401(K) PLAN 2023 465330632 2024-06-21 WORTHAM DENTAL, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-10-01
Business code 621210
Sponsor’s telephone number 2707486994
Plan sponsor’s address 3570 INDEPENDENCE DR, HOMEWOOD, AL, 352095710
WORTHAM DENTAL 401(K) PLAN 2022 465330632 2023-05-26 WORTHAM DENTAL, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-10-01
Business code 621210
Sponsor’s telephone number 2707486994
Plan sponsor’s address 3570 INDEPENDENCE DR, HOMEWOOD, AL, 352095710
WORTHAM DENTAL 401(K) PLAN 2021 465330632 2022-08-12 WORTHAM DENTAL, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-10-01
Business code 621210
Sponsor’s telephone number 2707486994
Plan sponsor’s address 3570 INDEPENDENCE DR, HOMEWOOD, AL, 352095710
WORTHAM DENTAL 401(K) PLAN 2020 465330632 2021-08-18 WORTHAM DENTAL, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-10-01
Business code 621210
Sponsor’s telephone number 2058712591
Plan sponsor’s address 1856 LANCASTER RD, BIRMINGHAM, AL, 35209

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2021-08-17
Name of individual signing CAROL HO
WORTHAM DENTAL 401(K) PLAN 2019 465330632 2020-05-20 WORTHAM DENTAL, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-10-01
Business code 621210
Sponsor’s telephone number 2058712591
Plan sponsor’s address 1856 LANCASTER RD, BIRMINGHAM, AL, 35209

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2020-05-20
Name of individual signing CAROL HO
WORTHAM DENTAL 401(K) PLAN 2018 465330632 2020-05-06 WORTHAM DENTAL, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-10-01
Business code 621210
Sponsor’s telephone number 2058712591
Plan sponsor’s address 1856 LANCASTER RD, BIRMINGHAM, AL, 35209

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2020-05-06
Name of individual signing CAROL HO
WORTHAM DENTAL 401(K) PLAN 2018 465330632 2019-07-17 WORTHAM DENTAL, LLC 6
Three-digit plan number (PN) 001
Effective date of plan 2018-10-01
Business code 621210
Sponsor’s telephone number 2058712591
Plan sponsor’s address 1856 LANCASTER RD, BIRMINGHAM, AL, 35209

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2019-07-17
Name of individual signing CAROL HO

Agent

Name Role Address
WORTHAM, BENJAMIN T Agent 1856 LANCASTER ROADHOMEWOOD, AL 35209

Organizer

Name Role Address
WORTHAM, BENJAMIN T Organizer 1856 LANCASTER ROADHOMEWOOD, AL 35209
WORTHAM, CLAY B Organizer 201 EAST MAIN STREET SUITE 900LEXINGTON, KY 40507

Related by officers

WORTHAM, BENJAMIN T

Wortham Service & Sales, LLC

Related by address

No related companies by address

Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State

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