| Name: | Children and Teen Dental Group of Alabama, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 08 Jan 2016 (9 years ago) |
| Entity Number: | 000-355-588 |
| Register Number: | 000355588 |
| County: | Tuscaloosa |
| Place of Formation: | Montgomery County |
| Registered Office Street Address: | 600 BOULEVARD S SW, STE 104UHUNTSVILLE, AL 35802-2175 |
| Principal Address: | 221 RICE MINE ROAD NE SUITE ATUSCALOOSA, AL 35406 |
| Principal Address ZIP Code: | 35406 |
| Authorized Capital: | 10000 @ $1.00PV |
Activities
PROFESSIONAL DENTAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205401304 | 2021-05-21 | 2021-05-21 | 342 N MAIN ST STE 200, ALPHARETTA, GA, 300098376, US | 4901 DEERFOOT PKWY STE 101, TRUSSVILLE, AL, 351732697, US | |||||||||||||||
|
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| Phone | +1 770-744-4522 |
| Phone | +1 205-655-1000 |
Authorized person
| Name | BRIAN SMITH |
| Role | COO |
| Phone | 7702315348 |
Taxonomy
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| Is Primary | Yes |
| Name | Role |
|---|---|
| FILEJET INC. | Agent |
| Name | Role | Address |
|---|---|---|
| MANNINO, MICHAEL | Incorporator | 999 PEACHTREE STREET NE SUITE 2300ATLANTA, GA 30309 |
| Name | Role | Address |
|---|---|---|
| BURGESS, JOHN BARRY | Director | 221 RICE MINE ROAD NE SUITE ATUSCALOOSA, AL 35406 |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
