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Complete Dental North Madison, LLC

Details

Name: Complete Dental North Madison, LLC
Jurisdiction: Alabama
Legal type: Domestic Series Limited Liability Company
Status: Exists
Date of registration: 04 Jan 2016 (9 years ago)
Entity Number: 000-352-792
Register Number: 000352792
County: Madison
Place of Formation: Madison County
Registered Office Street Address: 8097 MADISON BLVD SUITE 107MADISON, AL 35758
Registered Office Street Address ZIP Code: 35758

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1447619689 2016-02-16 2016-02-16 8141 US 72, SUITE. G, MADISON, AL, 35758, US 120 W DUBLIN DR, SUITE. 202, MADISON, AL, 357583155, US

Contacts

Phone +1 256-774-7228
Fax 2564645763
Phone +1 256-258-3883

Authorized person

Name MRS. TERESA J HAAKE
Role BILLING COORDINATOR
Phone 2562583883

Taxonomy

Taxonomy Code 1223G0001X - General Practice Dentistry
License Number 5311
State AL
Is Primary Yes

Organizer

Name Role Address
BURNEY, L JUSTIN Organizer 655 GALLATIN STHUNTSVILLE, AL 35801

Agent

Name Role Address
CHAMBLESS, BRANDON Agent 120 WEST DUBLIN SUITE 202MADISON, AL 35758

Date of last update: 03 Aug 2024

Sources: Alabama Secretary of State