| Name: | Marble City Pediatric Dentistry, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 06 Aug 2014 (10 years ago) |
| Entity Number: | 000-315-678 |
| Register Number: | 000315678 |
| County: | Shelby |
| Place of Formation: | Shelby County |
| Registered Office Street Address: | 141 NARROWS DRIVEBIRMINGHAM, AL 35242 |
| Registered Office Street Address ZIP Code: | 35242 |
| Authorized Capital: | 100 @ $1.00PV |
Activities
PROFESSIONAL DENTISTRY SERVICES & ALL MATTERS ANCILLARY THERETO
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114321643 | 2014-10-13 | 2014-10-13 | 1039 W FORT WILLIAMS ST, SYLACAUGA, AL, 351502301, US | 1039 W FORT WILLIAMS ST, SYLACAUGA, AL, 351502301, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 256-245-1399 |
| Fax | 2054088187 |
Authorized person
| Name | JONATHAN C CURTIS |
| Role | DENTIST |
| Phone | 2562451399 |
Taxonomy
| Taxonomy Code | 305R00000X - Preferred Provider Organization |
| License Number | 5263 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009934268 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| CURTIS, JONATHAN | Agent | 83 BURNHAM STREETBIRMINGHAM, AL 35242 |
| Name | Role | Address |
|---|---|---|
| CURTIS, JONATHAN | Director | 83 BURNHAM STREETBIRMINGHAM, AL 35242 |
| Name | Role | Address |
|---|---|---|
| CURTIS, JONATHAN | Incorporator | 83 BURNHAM STREETBIRMINGHAM, AL 35242 |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
