| Name: | North Mobile Dental Medicaid, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 29 Jun 2010 (14 years ago) |
| Date of dissolution: | 06 Nov 2019 |
| Entity Number: | 000-448-998 |
| Register Number: | 000448998 |
| County: | Mobile |
| Place of Formation: | Mobile County |
| Principal Address: | SARALAND, AL |
| Registered Office Street Address: | 1064 INDUSTRIAL PKWYSARALAND, AL 36571 |
| Registered Office Street Address ZIP Code: | 36571 |
Activities
ANY LAWFUL ACTIVITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275840415 | 2010-09-09 | 2010-09-09 | 1064 INDUSTRIAL PKWY, SARALAND, AL, 365713720, US | 1064 INDUSTRIAL PKWY, SARALAND, AL, 365713720, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 251-675-4313 |
| Fax | 2516754355 |
Authorized person
| Name | DR. SHONN M FARNI |
| Role | OWNER |
| Phone | 2516754313 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| License Number | 4781 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| License Number | 4782 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| License Number | 4784 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| License Number | 5712 |
| State | AL |
| Is Primary | No |
| Name | Role |
|---|---|
| FARNI, COURTLAND | Agent |
| Name | Role |
|---|---|
| FARNI, COURTLAND | Member |
| FARNI, SHONN | Member |
| GINN, LEO III | Member |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
