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Dentistry for Awesome Kids, LLC

Details

Name: Dentistry for Awesome Kids, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 03 Nov 2016 (8 years ago)
Entity Number: 000-375-690
Register Number: 000375690
County: Jefferson
Place of Formation: Jefferson County
Registered Office Street Address: 2090 COLUMBIANA ROAD, SUITE 2000BIRMINGHAM, AL 35216
Registered Office Street Address ZIP Code: 35216

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1124565676 2017-01-23 2017-01-23 623 8TH AVE W, BIRMINGHAM, AL, 352043604, US 623 8TH AVE W, BIRMINGHAM, AL, 352043604, US

Contacts

Phone +1 334-505-0891

Authorized person

Name LAUTEN JOHNSON
Role GENERAL DENTIST
Phone 2054470202

Taxonomy

Taxonomy Code 1223G0001X - General Practice Dentistry
Is Primary Yes

Other Provider Identifiers

Issuer MEDICAID
Number 1114368800
State AL
Issuer MEDICAID
Number 1992970545
State AL

Agent

Name Role Address
HASTY, WILLIAM D JR Agent 2090 COLUMBIANA ROAD STE 2000BIRMINGHAM, AL 35216

Organizer

Name Role Address
HASTY, WILLIAM D JR. Organizer 2090 COLUMBIANA ROAD SUITE 2000BIRMINGHAM, AL 35216

Date of last update: 13 Aug 2024

Sources: Alabama Secretary of State