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Pediatric & Adolescent Dentistry, LLC

Details

Name: Pediatric & Adolescent Dentistry, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 08 Feb 2007 (18 years ago)
Entity Number: 000-490-099
Register Number: 000490099
County: Jefferson
Place of Formation: Jefferson County
Registered Office Street Address: 2090 COLUMBIANA RD STE 2000BIRMINGHAM, AL 35216
Registered Office Street Address ZIP Code: 35216

Activities PEDIATRIC/ADOLESCENT DENTISTRY PRACTICE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1851585079 2007-08-30 2007-08-30 5346 STADIUM TRACE PKWY, SUITE 108, BIRMINGHAM, AL, 352444582, US 5346 STADIUM TRACE PKWY, SUITE 108, BIRMINGHAM, AL, 352444582, US

Contacts
Phone +1 205-982-0112
Fax 2059820737

Authorized person
Name DR. WILLIAM CLARK THOMAS
Role PRESIDENT
Phone 2059820112

Taxonomy
Taxonomy Code 1223P0221X - Pediatric Dentist
License Number 5122
State AL
Is Primary Yes

Other Provider Identifiers
Issuer BC/BS
Number 51540792
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PEDIATRIC & ADOLESCENT DENTISTRY 401(K) PLAN 2023 208451847 2024-10-13 PEDIATRIC & ADOLESCENT DENTISTRY 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 2059820112
Plan sponsor’s address 1015 BROCKS GAP PARKWAY, HOOVER, AL, 35244

Plan administrator’s name and address
Administrator’s EIN 582365498
Plan administrator’s name RETIREMENT PLAN ADMINISTRATORS, LLC
Plan administrator’s address 780 JOHNSON FERRY RD, SUITE 375, ATLANTA, GA, 30342
Administrator’s telephone number 4042556710
PEDIATRIC & ADOLESCENT DENTISTRY 401(K) PLAN 2022 208451847 2023-10-05 PEDIATRIC & ADOLESCENT DENTISTRY 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 2059820112
Plan sponsor’s address 1015 BROCKS GAP PARKWAY, HOOVER, AL, 35244

Plan administrator’s name and address
Administrator’s EIN 582365498
Plan administrator’s name RETIREMENT PLAN ADMINISTRATORS, LLC
Plan administrator’s address 780 JOHNSON FERRY RD, SUITE 375, ATLANTA, GA, 30342
Administrator’s telephone number 4042556710
PEDIATRIC & ADOLESCENT DENTISTRY 401(K) PLAN 2021 208451847 2022-10-10 PEDIATRIC & ADOLESCENT DENTISTRY 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 2059820112
Plan sponsor’s address 1015 BROCKS GAP PARKWAY, HOOVER, AL, 35244

Plan administrator’s name and address
Administrator’s EIN 582365498
Plan administrator’s name RETIREMENT PLAN ADMINISTRATORS, LLC
Plan administrator’s address 780 JOHNSON FERRY ROAD, ST 375, ATLANTA, GA, 30342
Administrator’s telephone number 4042556710
PEDIATRIC & ADOLESCENT DENTISTRY HEALTH AND WELFARE BENEFIT PLAN 2020 208451847 2021-10-11 PEDIATRIC & ADOLESCENT DENTISTRY 21
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2018-10-01
Business code 524140
Sponsor’s telephone number 2059820112
Plan sponsor’s address 1015 BROCKS GAP PKWY, HOOVER, AL, 35244

Plan administrator’s name and address
Administrator’s EIN 834125247
Plan administrator’s name ARSENAL HEALTH LLC
Plan administrator’s address 5151 HAMPSTEAD HIGH STREET, SUITE 200, MONTGOMERY, AL, 36116

Signature of
Role Plan administrator
Date 2021-10-06
Name of individual signing THOMAS BRITT TAYLOR
PEDIATRIC & ADOLESCENT DENTISTRY 401(K) PLAN 2020 208451847 2021-09-29 PEDIATRIC & ADOLESCENT DENTISTRY 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 2059820112
Plan sponsor’s address 1015 BROCKS GAP PARKWAY, HOOVER, AL, 35244

Plan administrator’s name and address
Administrator’s EIN 582365498
Plan administrator’s name RETIREMENT PLAN ADMINISTRATORS, LLC
Plan administrator’s address 780 JOHNSON FERRY RD. ST 375, ATLANTA, GA, 30342
Administrator’s telephone number 4042556710
PEDIATRIC & ADOLESCENT DENTISTRY 401K PLAN 2019 208451847 2020-07-21 PEDIATRIC & ADOLESCENT DENTISTRY 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 2059820112
Plan sponsor’s address 1015 BROCKS GAP PARKWAY, HOOVER, AL, 35244

Signature of
Role Plan administrator
Date 2020-07-21
Name of individual signing MOLLY WASHINGTON
Role Employer/plan sponsor
Date 2020-07-21
Name of individual signing MOLLY WASHINGTON

Member

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

Organizer

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

Agent

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

Related by officers

HASTY, WILLIAM D JR

Flint River Family Dentistry, LLC JHCH Properties, LLC Business Resource, LLC Bradford B Liles, DMD, P.C. NWW, LLC Clinical Optimization Group, LLC MMJ Group, LLC Lakeview Orthodontics, P.C. LMB Preferred Services, LLC Carlton Real Estate, LLC

Related by address

2090 COLUMBIANA RD STE 2000BIRMINGHAM, AL 35216

LMB Preferred Services, LLC True Services, LLC Hitchcock Properties, LLC Hitchcock Rx, Inc. Birmingham Wellness, LLC Cooley Insurance, Inc. Reflex Blue Media, Inc. Cornerstone Media, Inc. Rx Sunglass.com, Inc. Aces, Inc.

Date of last update: 14 Aug 2024

Sources: Alabama Secretary of State

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