| Name: | Big Wave Dentistry, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 09 Dec 2018 (6 years ago) |
| Entity Number: | 000-536-546 |
| Register Number: | 000536546 |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Registered Office Street Address: | 635 Glen Eagles AveGulf Shores, AL 36542 |
| Registered Office Street Address ZIP Code: | 36542 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184251100 | 2020-03-27 | 2020-03-27 | 635 GLEN EAGLES AVE, GULF SHORES, AL, 365429036, US | 110 S ALSTON ST, FOLEY, AL, 365351912, US | |||||||||||||||||||
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| Phone | +1 251-213-9820 |
Authorized person
| Name | DR. BRADLEY JOSHUA HILLMAN |
| Role | DENTIST/OWNER |
| Phone | 5012317666 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FFS |
| Number | 1447789045 |
| State | AL |
| Name | Role |
|---|---|
| Hillman, Bradley HIllman | Agent |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
