| Name: | Benjamin A. Crunk, DDS, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 08 Jun 2006 (18 years ago) |
| Date of dissolution: | 14 May 2019 |
| Entity Number: | 000-480-082 |
| Register Number: | 000480082 |
| County: | Shelby |
| Place of Formation: | Shelby County |
| Principal Address: | MONTEVALLO, AL |
| Registered Office Street Address: | 955 MAIN STMONTEVALLO, AL 35115 |
| Registered Office Street Address ZIP Code: | 35115 |
Activities
DENTISTRY PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083638746 | 2006-07-26 | 2008-06-23 | 980 MAIN ST, MONTEVALLO, AL, 351153846, US | 980 MAIN ST, MONTEVALLO, AL, 351153846, US | |||||||||||||||||||||||||
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| Phone | +1 205-665-2031 |
| Fax | 2056655560 |
Authorized person
| Name | DR. BENJAMIN ALAN CRUNK |
| Role | OWNER |
| Phone | 2056652031 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 4004 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BC/BS OF AL PROVIDER # |
| Number | 510-03995 |
| State | AL |
| Name | Role |
|---|---|
| CRUNK, BENJAMIN A | Agent |
| Name | Role |
|---|---|
| CRUNK, BENJAMIN A | Member |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
