| Name: | Alabama Pediatric Dentistry, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 01 Jun 2005 (19 years ago) (Companies founded in June 2005) |
| Entity Number: | 000-465-024 |
| Register Number: | 000465024 |
| ZIP code: | 35205 (Companies in Jefferson, 35205) |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 2112 FIFTH STREET SOUTHBIRMINGHAM, AL 35205 |
Activities
PEDIATRIC DENSISTRY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861673238 | 2007-11-14 | 2015-04-20 | 3500 INDEPENDENCE DR, STE 100, BIRMINGHAM, AL, 352092627, US | 3500 INDEPENDENCE DR, STE 100, BIRMINGHAM, AL, 352092687, US | |||||||||||||||||||||||
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| Phone | +1 205-802-7277 |
Authorized person
| Name | MICHELLE BAJJALIEH |
| Role | DENTIST |
| Phone | 2058027277 |
Taxonomy
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| License Number | 5189 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009934632 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| BAJJALIEH, MICHELLE | Agent | 2112 FIFTH ST SOUTHBIRMINGHAM, AL 35205 |
| Name | Role | Address |
|---|---|---|
| BAJJALIEH, MICHELLE | Member | 2112 FIFTH ST SOUTHBIRMINGHAM, AL 35205 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
