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Kellen A. Spivey Dental Services, LLC

Details

Name: Kellen A. Spivey Dental Services, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 01 Jul 2009 (15 years ago) (Companies founded in July 2009)
Entity Number: 000-435-548
Register Number: 000435548
ZIP code: 36206 (Companies in Calhoun, 36206)
County: Calhoun
Place of Formation: Calhoun County
Principal Address: ANNISTON, AL
Registered Office Street Address: 6118 MCCLELLAN BLVDANNISTON, AL 36206

Activities DENTISTRY PRACTICE/RELATED SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1962633255 2009-08-04 2009-08-04 6118 MCCLELLAN BLVD, ANNISTON, AL, 362068403, US 6118 MCCLELLAN BLVD, ANNISTON, AL, 362068403, US

Contacts
Phone +1 256-820-4821
Fax 2568202219

Authorized person
Name KELLEN SPIVEY
Role OWNER
Phone 2568204821

Taxonomy
Taxonomy Code 1223G0001X - General Practice Dentistry
License Number AL5704
State AL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SPIVEY FAMILY DENTISTRY 401(K) PLAN 2023 800433850 2024-05-13 KELLEN A. SPIVEY DENTAL SERVICES, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 2568204821
Plan sponsor’s address 6118 MCCLELLAN BOULEVARD, ANNISTON, AL, 36206

Signature of
Role Plan administrator
Date 2024-05-13
Name of individual signing KELLEN SPIVEY
SPIVEY FAMILY DENTISTRY 401(K) PLAN 2022 800433850 2023-06-11 KELLEN A. SPIVEY DENTAL SERVICES, LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 2568204821
Plan sponsor’s address 6118 MCCLELLAN BOULEVARD, ANNISTON, AL, 36206

Signature of
Role Plan administrator
Date 2023-06-11
Name of individual signing KELLEN SPIVEY
SPIVEY FAMILY DENTISTRY 401(K) PLAN 2021 800433850 2022-06-09 KELLEN A. SPIVEY DENTAL SERVICES, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 2568204821
Plan sponsor’s address 6118 MCCLELLAN BOULEVARD, ANNISTON, AL, 36206

Signature of
Role Plan administrator
Date 2022-06-09
Name of individual signing KELLEN SPIVEY
SPIVEY FAMILY DENTISTRY 401(K) PLAN 2020 800433850 2021-08-13 KELLEN A. SPIVEY DENTAL SERVICES, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 2568204821
Plan sponsor’s address 6118 MCCLELLAN BOULEVARD, ANNISTON, AL, 36206

Signature of
Role Plan administrator
Date 2021-08-13
Name of individual signing KELLEN SPIVEY
SPIVEY FAMILY DENTISTRY 401(K) PLAN 2019 800433850 2020-08-19 KELLEN A. SPIVEY DENTAL SERVICES, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 2568204821
Plan sponsor’s address 6118 MCCLELLAN BOULEVARD, ANNISTON, AL, 36206

Signature of
Role Plan administrator
Date 2020-08-19
Name of individual signing KELLEN SPIVEY
SPIVEY FAMILY DENTISTRY 401(K) PLAN 2018 800433850 2019-06-24 KELLEN A. SPIVEY DENTAL SERVICES, LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 2568204821
Plan sponsor’s address 6118 MCCLELLAN BLVD, ANNISTON, AL, 36206

Signature of
Role Plan administrator
Date 2019-06-24
Name of individual signing KELLEN SPIVEY
SPIVEY FAMILY DENTISTRY 401(K) PLAN 2017 800433850 2018-06-15 KELLEN A. SPIVEY DENTAL SERVICES, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 2568204821
Plan sponsor’s address 6118 MCCLELLAN BLVD, ANNISTON, AL, 36206

Signature of
Role Plan administrator
Date 2018-06-15
Name of individual signing KELLEN SPIVEY
SPIVEY FAMILY DENTISTRY 401(K) PLAN 2016 800433850 2017-06-27 KELLEN A. SPIVEY DENTAL SERVICES, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 2568204821
Plan sponsor’s address 6118 MCCLELLAN BLVD, ANNISTON, AL, 36206

Signature of
Role Plan administrator
Date 2017-06-27
Name of individual signing KELLEN SPIVEY
SPIVEY FAMILY DENTISTRY 401(K) PLAN 2015 800433850 2016-06-15 KELLEN A. SPIVEY DENTAL SERVICES, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 2568204821
Plan sponsor’s address 6118 MCCLELLAN BOULEVARD, ANNISTON, AL, 36206

Signature of
Role Plan administrator
Date 2016-06-15
Name of individual signing KELLEN SPIVEY
SPIVEY FAMILY DENTISTRY 401(K) PLAN 2014 800433850 2015-07-19 KELLEN A. SPIVEY DENTAL SERVICES, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 2568204821
Plan sponsor’s address 6118 MCCLELLAN BOULEVARD, ANNISTON, AL, 36206

Signature of
Role Plan administrator
Date 2015-07-19
Name of individual signing KELLEN SPIVEY

Agent

Name Role Address
SPIVEY, KELLEN A Agent 702 FAIRFIELD DR SWJACKSONVILLE, AL 36265

Member

Name Role Address
SPIVEY, KELLEN A Member 702 FAIRFIELD DR SWJACKSONVILLE, AL 36265

Related by officers

SPIVEY, KELLEN A

Spivey, REC, L.L.C.

Related by address

ANNISTON, AL

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Date of last update: 13 Aug 2024

Sources: Alabama Secretary of State

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