Lam-Geise Dentistry, LLC

Contacts

Phone	+1 256-461-8607

Authorized person

Name	DR. DIANE LAM GEISE
Role	PRESIDENT
Phone	3342209646

Taxonomy

Taxonomy Code	122300000X - Dentist
License Number	6107
State	AL
Is Primary	Yes
Taxonomy Code	122300000X - Dentist
License Number	5853
State	AL
Is Primary	No
Taxonomy Code	1223G0001X - General Practice Dentistry
License Number	4002
State	AL
Is Primary	No

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2017-01-01
Business code	621210
Sponsor’s telephone number	2568817080
Plan sponsor’s address	1111 GLENEAGLES DRIVE SW, HUNTSVILLE, AL, 35801

Signature of

Role	Plan administrator
Date	2022-09-13
Name of individual signing	JAMES GEISE

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2017-01-01
Business code	621210
Sponsor’s telephone number	2564618607
Plan sponsor’s address	577 HUGHES ROAD, MADISON, AL, 35758

Signature of

Role	Plan administrator
Date	2021-07-20
Name of individual signing	DIANE LAM GEISE

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2017-01-01
Business code	621210
Sponsor’s telephone number	2564618607
Plan sponsor’s address	577 HUGHES ROAD, MADISON, AL, 35758

Signature of

Role	Plan administrator
Date	2020-10-06
Name of individual signing	DIANE LAM GEISE

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2017-01-01
Business code	621210
Sponsor’s telephone number	2564618607
Plan sponsor’s address	577 HUGHES ROAD, MADISON, AL, 35758

Signature of

Role	Plan administrator
Date	2019-10-07
Name of individual signing	DIANE LAM GEISE

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2017-01-01
Business code	621210
Sponsor’s telephone number	2564618607
Plan sponsor’s address	577 HUGHES ROAD, MADISON, AL, 35758

Signature of

Role	Plan administrator
Date	2018-07-30
Name of individual signing	DIANE LAM GEISE