| Name: | Daleville Dental LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 19 Mar 2002 (23 years ago) (Companies founded in March 2002) |
| Entity Number: | 000-681-010 |
| Register Number: | 000681010 |
| ZIP code: | 36330 (Companies in Coffee, 36330) |
| County: | Coffee |
| Place of Formation: | Coffee County |
| Principal Address: | ENTERPRISE, AL |
| Registered Office Street Address: | 407 LAKE OLIVER DRENTERPRISE, AL 36330 |
Activities
DENTAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1760477251 | 2005-09-12 | 2020-08-22 | 526 N DALEVILLE AVE, DALEVILLE, AL, 363222000, US | 526 N DALEVILLE AVE, DALEVILLE, AL, 363222000, US | |||||||||||||||||||||||||||||
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| Phone | +1 334-598-4994 |
| Fax | 3345984342 |
Authorized person
| Name | DR. JAY MICHAEL WALTERS |
| Role | OWNER |
| Phone | 3345984994 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 4553 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | UCCI |
| Number | 820510 |
| Issuer | BC/BS |
| Number | 51525448 |
| State | AL |
| Name | Role |
|---|---|
| WALTERS, JAY | Agent |
| Name | Role |
|---|---|
| WALTERS, JAY | Member |
| WALTERS, DIANNE | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
