| Name: | Marilia P. Tate DMD, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 18 Nov 2014 (10 years ago) |
| Entity Number: | 000-323-111 |
| Register Number: | 000323111 |
| County: | Shelby |
| Place of Formation: | Jefferson County |
| Principal Address: | 3519 CONESTOGA WAYBIRMINGHAM, 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 @ $1.00PV |
| Paid Share Capital: | $100.00 |
Activities
DENTISTRY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114315785 | 2015-01-05 | 2015-01-05 | 2030 PATTON CHAPEL RD, BIRMINGHAM, AL, 352165770, US | 2030 PATTON CHAPEL RD, BIRMINGHAM, AL, 352165770, US | |||||||||||||||||||||||
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| Phone | +1 205-979-9491 |
Authorized person
| Name | DR. MARILIA P. TATE |
| Role | OWNER/PRESIDENT |
| Phone | 2059799491 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| License Number | 5939 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD OF AL |
| Number | 511-45494 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| HASTY, WILLIAM D JR | Agent | 2090 COLUMBIANA ROAD STE 2000BIRMINGHAM, AL 35216 |
| Name | Role | Address |
|---|---|---|
| TATE, MARILIA P | Director | 3519 CONESTOGA WAYBIRMINGHAM, AL 35242 |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
