| Name: | Rainsville Pediatric Dental Village, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 11 May 2005 (20 years ago) (Companies founded in May 2005) |
| Entity Number: | 000-464-311 |
| Register Number: | 000464311 |
| Historical Names: |
Tara L. Moncus, D.M.D., L.L.C.
|
| ZIP code: | 35986 (Companies in De Kalb, 35986) |
| County: | De Kalb |
| Place of Formation: | DeKalb County |
| Principal Address: | RAINSVILLE, AL |
| Registered Office Street Address: | 85 CHURCH STREETRAINSVILLE, AL 35986 |
Activities
ANY LAWFUL ACTIVITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871976399 | 2015-07-01 | 2015-07-01 | 371 MCCURDY AVE S, RAINSVILLE, AL, 359865215, US | 371 MCCURDY AVE S, RAINSVILLE, AL, 359865215, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 256-638-3000 |
| Fax | 2566383099 |
Authorized person
| Name | DR. TARA L MONCUS |
| Role | DENTSIT/OWNER |
| Phone | 2566383000 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 6198 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| License Number | 5126 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1003811241 |
| State | AL |
| Name | Role |
|---|---|
| MONCUS, TARA L | Agent |
| Name | Role |
|---|---|
| MONCUS, TARA L | Member |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2009-07-14 | Name Change | Tara L. Moncus, D.M.D., L.L.C. | Rainsville Pediatric Dental Village, L.L.C. |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
