| Name: | Iron City Dentistry, PC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 31 Jan 2018 (7 years ago) |
| Entity Number: | 000-508-102 |
| Register Number: | 000508102 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | 5524 11TH AVENUE SOUTHBIRMINGHAM, AL 35222 |
| Principal Address ZIP Code: | 35222 |
| Authorized Capital: | 1,000 @ $.01/PV |
Activities
RENDER PROFESSIONAL DENTAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679075600 | 2018-03-06 | 2018-03-06 | 220 WALKER RD, BIRMINGHAM, AL, 352143138, US | 220 WALKER RD, BIRMINGHAM, AL, 352143138, US | |||||||||||||||||||
|
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| Phone | +1 205-798-1780 |
Authorized person
| Name | DR. LESLIE ANN FRESE |
| Role | DENTIST/OWNER |
| Phone | 2057678610 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1477946218 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| FRESE, LESLIE | Agent | 5524 11TH AVENUE SOUTHBIRMINGHAM, AL 35222 |
| Name | Role | Address |
|---|---|---|
| FRESE, LESLIE | Director | 5524 11TH AVENUE SOUTHBIRMINGHAM, AL 35222 |
| Name | Role | Address |
|---|---|---|
| ANDERSON, BRAD S | Incorporator | 1819 5TH AVENUE NORTH, SUITE 1000BIRMINGHAM, AL 35203-1112 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
