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