Gibson Family Dentistry, LLC

Contacts

Phone	+1 256-237-0603

Authorized person

Name	DR. MORGAN DUFFY GIBSON
Role	DENTIST/OWNER
Phone	2562370603

Taxonomy

Taxonomy Code	261QD0000X - Dental Clinic/Center
License Number	6325
State	AL
Is Primary	Yes

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2013-01-01
Business code	621210
Sponsor’s telephone number	2562370603
Plan sponsor’s address	609 GOLDEN SPRINGS ROAD, ANNISTON, AL, 36207

Signature of

Role	Plan administrator
Date	2024-09-23
Name of individual signing	MORGAN GIBSON
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2013-01-01
Business code	621210
Sponsor’s telephone number	2562370603
Plan sponsor’s address	313 EAST 10TH STREET, ANNISTON, AL, 36207

Signature of

Role	Plan administrator
Date	2023-09-08
Name of individual signing	MORGAN GIBSON

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2013-01-01
Business code	621210
Sponsor’s telephone number	2562370603
Plan sponsor’s address	313 EAST 10TH STREET, ANNISTON, AL, 36207

Signature of

Role	Plan administrator
Date	2022-10-17
Name of individual signing	MORGAN GIBSON

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2013-01-01
Business code	621210
Sponsor’s telephone number	2562370603
Plan sponsor’s address	313 EAST 10TH STREET, ANNISTON, AL, 36207

Signature of

Role	Plan administrator
Date	2021-05-27
Name of individual signing	MORGAN GIBSON

Three-digit plan number (PN)	001
Effective date of plan	2013-01-01
Business code	621210
Sponsor’s telephone number	2562370603
Plan sponsor’s address	313 EAST 10TH STREET, ANNISTON, AL, 36207

Signature of

Role	Plan administrator
Date	2020-10-06
Name of individual signing	MORGAN GIBSON, DMD

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2013-01-01
Business code	621210
Sponsor’s telephone number	2562370603
Plan sponsor’s address	313 EAST 10TH STREET, ANNISTON, AL, 36207

Signature of

Role	Plan administrator
Date	2021-04-21
Name of individual signing	MORGAN GIBSON, DMD

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2013-01-01
Business code	621210
Sponsor’s telephone number	2562370603
Plan sponsor’s address	313 EAST 10TH STREET, ANNISTON, AL, 36207

Signature of

Role	Plan administrator
Date	2020-12-01
Name of individual signing	MORGAN GIBSON, DMD

Three-digit plan number (PN)	001
Effective date of plan	2013-01-01
Business code	621210
Sponsor’s telephone number	2562370603
Plan sponsor’s address	313 EAST 10TH STREET, ANNISTON, AL, 36207

Signature of

Role	Plan administrator
Date	2019-09-30
Name of individual signing	MORGAN GIBSON, DMD

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2013-01-01
Business code	621210
Sponsor’s telephone number	2562370603
Plan sponsor’s address	313 EAST 10TH STREET, ANNISTON, AL, 36207

Signature of

Role	Plan administrator
Date	2018-10-15
Name of individual signing	MORGAN GIBSON, DMD