| Name: | Benjamin D Williams Dental Group, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 17 Jul 2018 (6 years ago) |
| Entity Number: | 000-524-334 |
| Register Number: | 000524334 |
| Historical Names: |
Benjamin D Williams Properties, LLC
|
| County: | Shelby |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 501 BOULDER LAKE WAYBIRMINGHAM, AL 35242 |
| Registered Office Street Address ZIP Code: | 35242 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942458286 | 2008-08-28 | 2019-06-07 | 1715 GOLDEN SPRINGS ROAD, ANNISTON, AL, 36207, US | 1715 GOLDEN SPRINGS ROAD, ANNISTON, AL, 36207, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 256-231-0077 |
| Fax | 2562310866 |
Authorized person
| Name | BENJAMIN D WILLIAMS |
| Role | OWNER |
| Phone | 2562310077 |
Taxonomy
| Taxonomy Code | 1223P0300X - Periodontist |
| License Number | AL4736 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| License Number | 4736 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD OF AL |
| Number | 510-10222 |
| State | AL |
| Name | Role |
|---|---|
| WILLIAMS, BENJAMIN D | Agent |
| Name | Role |
|---|---|
| SHEEDY, BREET S | Organizer |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2018-08-07 | Name Change | Benjamin D Williams Properties, LLC | Benjamin D Williams Dental Group, LLC |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
