| 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) |
| Entity Number: | 000-348-201 |
| Register Number: | 000348201 |
| County: | Shelby |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 123 N CHALKVILLE ROAD SUITE #1TRUSSVILLE, AL 35137 |
| Registered Office Street Address ZIP Code: | 35137 |
| 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 | |||||||||||||
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| 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 |
| Name | Role |
|---|---|
| WILLINGHAM, THOMAS G JR | Agent |
| 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
