| Name: | Dental Associates of Tuscaloosa, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 31 Dec 2001 (23 years ago) |
| Date of dissolution: | 29 Oct 2018 |
| Entity Number: | 000-679-369 |
| Register Number: | 000679369 |
| County: | Tuscaloosa |
| Place of Formation: | Tuscaloosa County |
| Principal Address: | TUSCALOOSA, AL |
| Registered Office Street Address: | 217 MCFARLAND CIRCLE NORTHTUSCALOOSA, AL 35406 |
| Registered Office Street Address ZIP Code: | 35406 |
Activities
DENTAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942394820 | 2006-10-03 | 2020-08-22 | 217 MCFARLAND CIRCLE NORTH, TUSCALOOSA, AL, 34506, US | 217 MCFARLAND CIRCLE NORTH, TUSCALOOSA, AL, 34506, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 205-345-7755 |
| Fax | 2053439075 |
Authorized person
| Name | JERRY ANDREW FIKES |
| Role | OWNER DENTIST |
| Phone | 2053457755 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| License Number | 3162 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 122300000X - Dentist |
| License Number | 5177 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51506076 |
| State | AL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51526480 |
| State | AL |
| Name | Role |
|---|---|
| FIKES, JERRY A | Agent |
| Name | Role |
|---|---|
| FIKES, JERRY A | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
