| Name: | Dental Associates of Athens, PLLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Limited Liability Company |
| Status: | Exists |
| Date of registration: | 07 Aug 2007 (17 years ago) (Companies founded in August 2007) |
| Entity Number: | 000-498-534 |
| Register Number: | 000498534 |
| Historical Names: |
Dental Associates of Athens, LLC
|
| ZIP code: | 35612 (Companies in Limestone, 35612) |
| County: | Limestone |
| Place of Formation: | Limestone County |
| Registered Office Street Address: | 2 NORTH JACKSON STREET - SUITE 605MONTGOMERY, AL 36104 |
| Principal Address: | 1005 WEST MARKET STREET, STE. #3ATHENS, AL 35612 |
Activities
DENTISTRY PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386917631 | 2012-02-17 | 2012-02-17 | 1005 W MARKET ST, ATHENS, AL, 356112454, US | 1005 W MARKET ST, ATHENS, AL, 356112454, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 256-232-1404 |
| Fax | 2562306738 |
Authorized person
| Name | MRS. TERRI WRENN |
| Role | ADMINISTRATIVE ASSISTANT |
| Phone | 2563535600 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 5540 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS AL |
| Number | 515-43170 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| C T CORPORATION SYSTEM | Agent | 2 NORHT JACKSON STREET SUITE 605MONTGOMERY, AL 36104 |
| Name | Role | Address |
|---|---|---|
| HAWKINS, GREG | Member | 1408 7TH AVE SEDECATUR, AL 35601 |
| HAWKINS, RILEY | Member | 1408 7TH AVE SEDECATUR, AL 35601 |
| GALES, ANTONIO E | Member | 1408 7TH AVE SEDECATUR, AL 35601 |
| HARRIS, JEREMIAH L | Member | 1408 7TH AVE SEDECATUR, AL 35601 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2022-11-09 | Name Change | Dental Associates of Athens, LLC | Dental Associates of Athens, PLLC |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
