Eastern Shore Oral, Facial And Implant Surgery Center, P.C.

Details

Name:	Eastern Shore Oral, Facial And Implant Surgery Center, P.C.
Jurisdiction:	Alabama
Legal type:	Domestic Professional Corporation
Status:	Exists
Date of registration:	18 Jan 2017 (8 years ago)
Entity Number:	000-381-146
Register Number:	000381146
County:	Baldwin
Place of Formation:	Baldwin County
Registered Office Street Address:	24172 4TH STREETFAIRHOPE, AL 36532
Registered Office Street Address ZIP Code:	36532
Principal Address:	7336 WILKINS CREEK CTSPANISH FORT, AL 36527
Principal Address ZIP Code:	36527
Authorized Capital:	1,000 @ $.001PV

Activities HEALTH CARE DENTIST

National Provider Identifier

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1568985349

2017-07-24

2022-07-21

24172 4TH STREET, FAIRHOPE, AL, 36532, US

24172 4TH STREET, FAIRHOPE, AL, 36532, US

Contacts

Phone	+1 251-333-1700
Fax	2513331701

Authorized person

Name	RICHARD CORDERO
Role	OWNER/ SURGEON
Phone	2513331700

Taxonomy

Taxonomy Code	261QS0112X - Oral and Maxillofacial Surgery Clinic/Center
License Number	6357
State	AL
Is Primary	Yes

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

EASTERN SHORE RETIREMENT PLAN & TRUST

2023

815096429

2024-10-03

EASTERN SHORE ORAL, FACIAL AND IMPLANT SURGERY CENTER, P.C.

18

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2019-01-01
Business code	621210
Sponsor’s telephone number	2513331700
Plan sponsor’s address	24172 4TH STREET, FAIRHOPE, AL, 36532

EASTERN SHORE RETIREMENT PLAN & TRUST

2022

815096429

2023-08-22

EASTERN SHORE ORAL, FACIAL AND IMPLANT SURGERY CENTER, P.C.

15

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2019-01-01
Business code	621210
Sponsor’s telephone number	2513331700
Plan sponsor’s address	24172 4TH STREET, FAIRHOPE, AL, 36532

EASTERN SHORE RETIREMENT PLAN & TRUST

2021

815096429

2022-09-26

EASTERN SHORE ORAL, FACIAL AND IMPLANT SURGERY CENTER, P.C.

12

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2019-01-01
Business code	621210
Sponsor’s telephone number	2513331700
Plan sponsor’s address	24172 4TH STREET, FAIRHOPE, AL, 36532

EASTERN SHORE RETIREMENT PLAN & TRUST

2020

815096429

2021-11-29

EASTERN SHORE ORAL, FACIAL AND IMPLANT SURGERY CENTER, P.C.

6

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2019-01-01
Business code	621210
Sponsor’s telephone number	2513331700
Plan sponsor’s address	24172 4TH STREET, FAIRHOPE, AL, 36532

EASTERN SHORE RETIREMENT PLAN & TRUST

2020

815096429

2021-09-29

EASTERN SHORE ORAL, FACIAL AND IMPLANT SURGERY CENTER, P.C.

6

Three-digit plan number (PN)	001
Effective date of plan	2019-01-01
Business code	621210
Sponsor’s telephone number	2513331700
Plan sponsor’s address	24172 4TH STREET, FAIRHOPE, AL, 36532

EASTERN SHORE RETIREMENT PLAN & TRUST

2019

815096429

2020-09-14

EASTERN SHORE ORAL, FACIAL AND IMPLANT SURGERY CENTER, P.C.

4

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2019-01-01
Business code	621210
Sponsor’s telephone number	2513331700
Plan sponsor’s address	24172 4TH STREET, FAIRHOPE, AL, 36532

Agent

Name	Role	Address
CORDERO, RICHARD	Agent	7336 WILKINS CREEK CTSPANISH FORT, AL 36527

Director

Name	Role	Address
CORDERO, RICHARD	Director	7336 WILKINS CREEK CTSPANISH FORT, AL 36527

Incorporator

Name	Role	Address
LEGALZOOM.COM INC	Incorporator	101 N BRAND BLVD 10TH FLOORGLENDALE, CA 91203

Date of last update: 13 Aug 2024

Sources: Alabama Secretary of State