| Name: | Bush Pediatric Dentistry, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 07 Nov 2016 (8 years ago) (Companies founded in November 2016) |
| Entity Number: | 000-375-795 |
| Register Number: | 000375795 |
| ZIP code: | 36111 (Companies in Montgomery, 36111) |
| County: | Montgomery |
| Place of Formation: | Covington County |
| Principal Address: | 3370 Thomas AvenueMontgomery, AL 36111 |
| Registered Office Street Address: | 209 WOODSIDE DRIVEBIRMINGHAM, AL 35210 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578091815 | 2017-05-31 | 2017-05-31 | 3420 LANSDOWNE DR, MONTGOMERY, AL, 361112115, US | 4740 WOODMERE BLVD, MONTGOMERY, AL, 361063065, US | |||||||||||||||||||||
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| Phone | +1 334-504-0142 |
| Phone | +1 334-676-2144 |
| Fax | 3346762148 |
Authorized person
| Name | DR. SAMUEL WAYNE BUSH |
| Role | DENTIST/OWNER |
| Phone | 3345040142 |
Taxonomy
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| License Number | 6240 |
| State | AL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BUSH PEDIATRIC DENTISTRY 401(K) & PROFIT SHARING PLAN | 2023 | 814881386 | 2024-08-23 | BUSH PEDIATRIC DENTISTRY | 14 | |||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-08-23 |
| Name of individual signing | SAMUEL BUSH |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 3345040142 |
| Plan sponsor’s address | 4740 WOODMERE BOULEVARD, MONTGOMERY, AL, 36106 |
Signature of
| Role | Plan administrator |
| Date | 2023-03-15 |
| Name of individual signing | SAMUEL BUSH |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 3345040142 |
| Plan sponsor’s address | 4740 WOODMERE BOULEVARD, MONTGOMERY, AL, 36106 |
Signature of
| Role | Plan administrator |
| Date | 2022-06-15 |
| Name of individual signing | SAMUEL BUSH |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 3345040142 |
| Plan sponsor’s address | 4740 WOODMERE BOULEVARD, MONTGOMERY, AL, 36106 |
Signature of
| Role | Plan administrator |
| Date | 2021-07-13 |
| Name of individual signing | SAMUEL BUSH |
| Name | Role |
|---|---|
| BUSH, SAMUEL W | Agent |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
