| Name: | Willow Dental, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 28 Oct 2019 (5 years ago) (Companies founded in October 2019) |
| Date of dissolution: | 11 Mar 2024 |
| Entity Number: | 000-591-648 |
| Register Number: | 000591648 |
| ZIP code: | 35645 (Companies in Lauderdale, 35645) |
| County: | Lauderdale |
| Place of Formation: | Lauderdale County |
| Registered Office Street Address: | 1303 HWY 72KILLEN, AL 35645 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851936942 | 2019-11-12 | 2019-11-12 | 515 COUNTY ROAD 402, KILLEN, AL, 356455815, US | 1367 HIGHWAY 72, KILLEN, AL, 356459136, US | |||||||||||||||||||||
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| Phone | +1 256-810-3955 |
| Phone | +1 256-757-5313 |
Authorized person
| Name | STACEY L EVANS |
| Role | MANAGER |
| Phone | 2568103955 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1003969312 |
| State | AL |
| Name | Role |
|---|---|
| EVANS, BRUCE D | Agent |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
