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Pediatric Dental Associates of Birmingham, LLC

Details

Name: Pediatric Dental Associates of Birmingham, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 05 Nov 2015 (9 years ago) (Companies founded in November 2015)
Entity Number: 000-348-201
Register Number: 000348201
ZIP code: 35137 (Companies in Shelby, 35137)
County: Shelby
Place of Formation: Jefferson County
Registered Office Street Address: 123 N CHALKVILLE ROAD SUITE #1TRUSSVILLE, AL 35137

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1952774945 2015-11-12 2015-11-12 1613 11TH AVE S, BIRMINGHAM, AL, 352054703, US 1613 11TH AVE S, BIRMINGHAM, AL, 352054703, US

Contacts

Phone +1 205-586-9922

Authorized person

Name DR. THOMAS G WILLINGHAM JR.
Role PARTNER
Phone 2055869922

Taxonomy

Taxonomy Code 1223P0221X - Pediatric Dentist
Is Primary Yes

Agent

Name Role
WILLINGHAM, THOMAS G JR Agent

Organizer

Name Role Address
GEISEN, JONATHAN R Organizer 420 20TH STREET NORTH, SUITE 1400BIRMINGHAM, AL 35203

Date of last update: 03 Aug 2024

Sources: Alabama Secretary of State