| Name: | PDA Orthodontics, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 09 May 2019 (6 years ago) |
| Entity Number: | 000-575-143 |
| Register Number: | 000575143 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 3000 SOUTHLAKE PARK #200BIRMINGHAM, AL 35244 |
| Registered Office Street Address ZIP Code: | 35244 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942855176 | 2019-08-05 | 2023-09-12 | 5564 GROVE BLVD STE A, HOOVER, AL, 352264601, US | 5564 GROVE BLVD STE A, HOOVER, AL, 352264601, US | |||||||||||||||
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| Phone | +1 205-988-9678 |
| Fax | 2059889065 |
Authorized person
| Name | DR. BENJAMIN EARL SAMUELSON |
| Role | ORTHODONTIST/PARTNER |
| Phone | 2059100143 |
Taxonomy
| Taxonomy Code | 1223X0400X - Orthodontics and Dentofacial Orthopedic Dentist |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CHAMBLISS, RICHARD B JR | Agent | 3000 SOUTHLAKE PARK #200BIRMINGHAM, AL 35244 |
| Name | Role | Address |
|---|---|---|
| CHAMBLISS, RICHARD B JR | Organizer | 3000 SOUTHLAKE PARK #200BIRMINGHAM, AL 35244 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
