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Pediatric Smiles, LLC

Details

Name: Pediatric Smiles, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 20 Apr 2010 (15 years ago)
Entity Number: 000-446-201
Register Number: 000446201
County: Jefferson
Place of Formation: Jefferson County
Principal Address: BIRMINGHAM, AL
Registered Office Street Address: 2090 COLUMBIANA RD STE 2000BIRMINGHAM, AL 35216
Registered Office Street Address ZIP Code: 35216

Activities PEDIATRIC DENTISTRY

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1003136615 2010-06-04 2010-10-19 5751 POCAHONTAS ROAD, SUITE B, BESSEMER, AL, 35022, US 5751 POCAHONTAS ROAD, SUITE B, BESSEMER, AL, 350225711, US

Contacts
Phone +1 205-230-9000
Phone +1 205-451-7029

Authorized person
Name DR. TABITHA JARMAN GATREY
Role OWNER/DENTIST
Phone 2054517029

Taxonomy
Taxonomy Code 1223P0221X - Pediatric Dentist
License Number 5647
State AL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PEDIATRIC SMILES LLC 2023 800584404 2024-07-23 PEDIATRIC SMILES LLC 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-02-01
Business code 621210
Sponsor’s telephone number 2054517029
Plan sponsor’s address 5910 HARRIS LANE, BESSEMER, AL, 35022

Signature of
Role Plan administrator
Date 2024-07-23
Name of individual signing TABITHA GATREY
PEDIATRIC SMILES LLC 2022 800584404 2023-10-13 PEDIATRIC SMILES LLC 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-02-01
Business code 621210
Sponsor’s telephone number 2054517029
Plan sponsor’s address 4823 PROMENADE PKWY, SUITE 101, BESSEMER, AL, 35022

Signature of
Role Plan administrator
Date 2023-10-13
Name of individual signing TABITHA GATREY
PEDIATRIC SMILES LLC 2021 800584404 2022-06-13 PEDIATRIC SMILES LLC 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-02-01
Business code 621210
Sponsor’s telephone number 2054517029
Plan sponsor’s address 4823 PROMENADE PKWY, SUITE 101, BESSEMER, AL, 35022

Signature of
Role Plan administrator
Date 2022-06-13
Name of individual signing TABITHA GATREY
PEDIATRIC SMILES LLC 2020 800584404 2021-06-22 PEDIATRIC SMILES LLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-02-01
Business code 621210
Sponsor’s telephone number 2054517029
Plan sponsor’s address 4823 PROMENADE PKWY, SUITE 101, BESSEMER, AL, 35022

Signature of
Role Plan administrator
Date 2021-06-22
Name of individual signing TABITHA GATREY
PEDIATRIC SMILES LLC 2019 800584404 2020-10-10 PEDIATRIC SMILES LLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-02-01
Business code 621210
Sponsor’s telephone number 2054517029
Plan sponsor’s address 4823 PROMENADE PKWY, SUITE 101, BESSEMER, AL, 35022

Signature of
Role Plan administrator
Date 2020-10-10
Name of individual signing TABITHA GATREY
PEDIATRIC SMILES LLC 2018 800584404 2019-06-28 PEDIATRIC SMILES LLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-02-01
Business code 621210
Sponsor’s telephone number 2054517029
Plan sponsor’s address 4823 PROMENADE PKWY, SUITE 101, BESSEMER, AL, 35022

Signature of
Role Plan administrator
Date 2019-06-28
Name of individual signing TABITHA GATREY
PEDIATRIC SMILES LLC 2017 800584404 2018-08-02 PEDIATRIC SMILES LLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-02-01
Business code 621210
Sponsor’s telephone number 2054517029
Plan sponsor’s address 4823 PROMENADE PKWY, SUITE 101, BESSEMER, AL, 35022

Signature of
Role Plan administrator
Date 2018-08-02
Name of individual signing TABITHA GATREY
PEDIATRIC SMILES LLC 2016 800584404 2017-11-10 PEDIATRIC SMILES LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-02-01
Business code 621210
Sponsor’s telephone number 2054517029
Plan sponsor’s address 4823 PROMENADE PARKWAY SUITE 101, BESSEMER, AL, 35022

Signature of
Role Plan administrator
Date 2017-11-10
Name of individual signing TABITHA GATREY

Agent

Name Role Address
HASTY, WILLIAM D JR Agent 2090 COLUMBIANA ROAD STE 2000BIRMINGHAM, AL 35216

Member

Name Role
GATREY, TABITHA JARMAN Member

Related by officers

HASTY, WILLIAM D JR

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2090 COLUMBIANA RD STE 2000BIRMINGHAM, AL 35216

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Date of last update: 13 Aug 2024

Sources: Alabama Secretary of State

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