| Name: | Jasper Pediatric Dentistry, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 29 Jan 2002 (23 years ago) (Companies founded in January 2002) |
| Entity Number: | 000-680-052 |
| Register Number: | 000680052 |
| ZIP code: | 35501 (Companies in Walker, 35501) |
| County: | Walker |
| Place of Formation: | Walker County |
| Principal Address: | JASPER, AL |
| Registered Office Street Address: | 4330 HIGHWAY 78 EAST STE 121JASPER, AL 35501 |
Activities
DELIVER ROUTINE/PREVENTIVE DENTAL CARE TO CHILDREN/ADOLESCENTS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1649303355 | 2007-03-13 | 2020-08-22 | 4330 HIGHWAY 78 E, SUITE 121, JASPER, AL, 355018905, US | 4330 HIGHWAY 78 E, SUITE 121, JASPER, AL, 355018905, US | |||||||||||||||||||||||||
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| Phone | +1 205-384-9104 |
| Fax | 2053849102 |
Authorized person
| Name | DR. KATRINA CAROL WHITE |
| Role | OWNER |
| Phone | 2053849104 |
Taxonomy
| Taxonomy Code | 1223P0221X - Pediatric Dentist |
| License Number | 4967 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS |
| Number | 51506630 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JASPER PEDIATRIC DENTISTRY, LLC 401(K) P/S PLAN | 2009 | 954894550 | 2010-06-24 | JASPER PEDIATRIC DENTISTRY, LLC | 20 | |||||||||||||||||||||||||||||
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| Administrator’s EIN | 954894550 |
| Plan administrator’s name | JASPER PEDIATRIC DENTISTRY, LLC |
| Plan administrator’s address | 1400 HIGHWAY 78 W., SUITE 300, JASPER, AL, 35501 |
| Administrator’s telephone number | 2053849104 |
Signature of
| Role | Plan administrator |
| Date | 2010-06-24 |
| Name of individual signing | KATRINA WHITE |
| Name | Role |
|---|---|
| WHITE, KATRINA C | Member |
| Name | Role |
|---|---|
| WHITE, KATRINA C | Agent |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
