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Ashville Family Dentistry, LLC

Details

Name: Ashville Family Dentistry, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 10 Jan 2003 (22 years ago)
Entity Number: 000-687-304
Register Number: 000687304
Historical Names: Lincoln Family Dentistry, LLC
County: Jefferson
Place of Formation: Jefferson County
Principal Address: BIRMINGHAM, AL
Registered Office Street Address: 210 HAYGOOD STBIRMINGHAM, AL 35213
Registered Office Street Address ZIP Code: 35213

Activities PROFESSIONAL DENTAL SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1427418441 2016-03-03 2016-03-03 PO BOX 129, ASHVILLE, AL, 359530129, US 279 5TH AVE, ASHVILLE, AL, 359533339, US

Contacts
Phone +1 205-594-5044

Authorized person
Name JASON BRENT JORDAN
Role OWNER
Phone 2055945044

Taxonomy
Taxonomy Code 261QD0000X - Dental Clinic/Center
License Number 5192
State AL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 009955935
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ASHVILLE FAMILY DENTISTRY LLC 401(K) PROFIT SHARING PLAN & TRUST 2023 611439470 2024-06-24 ASHVILLE FAMILY DENTISTRY LLC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2021-01-01
Business code 812990
Sponsor’s telephone number 2059573334
Plan sponsor’s address 279 5TH AVE PO BOX 129, ASHVILLE, AL, 35953

Signature of
Role Plan administrator
Date 2024-06-24
Name of individual signing EDWARD ROJAS
ASHVILLE FAMILY DENTISTRY LLC 401(K) PROFIT SHARING PLAN & TRUST 2022 611439470 2023-04-10 ASHVILLE FAMILY DENTISTRY LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2021-01-01
Business code 812990
Sponsor’s telephone number 2059573334
Plan sponsor’s address 279 5TH AVE PO BOX 129, ASHVILLE, AL, 35953

Signature of
Role Plan administrator
Date 2023-04-10
Name of individual signing JASON B JORDAN
ASHVILLE FAMILY DENTISTRY LLC 401(K) PROFIT SHARING PLAN & TRUST 2021 611439470 2022-04-07 ASHVILLE FAMILY DENTISTRY LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2021-01-01
Business code 812990
Sponsor’s telephone number 2059573334
Plan sponsor’s address 279 5TH AVE PO BOX 129, ASHVILLE, AL, 35953

Signature of
Role Plan administrator
Date 2022-04-07
Name of individual signing JASON B JORDAN
ASHVILLE FAMILY DENTISTRY LLC 401(K) PROFIT SHARING PLAN & TRUST 2018 611439470 2020-07-07 ASHVILLE FAMILY DENTISTRY LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Plan sponsor’s address PO BOX 129, ASHVILLE, AL, 359530129

Signature of
Role Plan administrator
Date 2020-07-07
Name of individual signing JASON JORDAN
Role Employer/plan sponsor
Date 2020-07-07
Name of individual signing JASON JORDAN
ASHVILLE FAMILY DENTISTRY LLC 401 K PROFIT SHARING PLAN TRUST 2017 611439470 2018-07-21 ASHVILLE FAMILY DENTISTRY LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2055945044
Plan sponsor’s address PO BOX 129, ASHVILLE, AL, 359530129

Signature of
Role Plan administrator
Date 2018-07-21
Name of individual signing JASON JORDAN
ASHVILLE FAMILY DENTISTRY LLC 401 K PROFIT SHARING PLAN TRUST 2016 611439470 2017-07-04 ASHVILLE FAMILY DENTISTRY LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2055945044
Plan sponsor’s address PO BOX 129, ASHVILLE, AL, 359530129

Signature of
Role Plan administrator
Date 2017-07-04
Name of individual signing JASON B. JORDAN
ASHVILLE FAMILY DENTISTRY LLC 401 K PROFIT SHARING PLAN TRUST 2015 611439470 2016-08-02 ASHVILLE FAMILY DENTISTRY LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2055945044
Plan sponsor’s address PO BOX 129, ASHVILLE, AL, 359530129

Signature of
Role Plan administrator
Date 2016-08-02
Name of individual signing JASON JORDAN
ASHVILLE FAMILY DENTISTRY LLC 401 K PROFIT SHARING PLAN TRUST 2014 611439470 2015-05-26 ASHVILLE FAMILY DENTISTRY LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2055945044
Plan sponsor’s address PO BOX 129, ASHVILLE, AL, 359530129

Signature of
Role Plan administrator
Date 2015-05-26
Name of individual signing JASON B. JORDAN
ASHVILLE FAMILY DENTISTRY LLC 401 K PROFIT SHARING PLAN TRUST 2013 611439470 2014-06-03 ASHVILLE FAMILY DENTISTRY LLC 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2055945044
Plan sponsor’s address PO BOX 129, ASHVILLE, AL, 359530129

Signature of
Role Plan administrator
Date 2014-06-03
Name of individual signing JASON JORDAN
ASHVILLE FAMILY DENTISTRY LLC 401 K PROFIT SHARING PLAN TRUST 2012 611439470 2013-06-01 ASHVILLE FAMILY DENTISTRY LLC 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2055945044
Plan sponsor’s address PO BOX 129, ASHVILLE, AL, 359530129

Signature of
Role Plan administrator
Date 2013-06-01
Name of individual signing ASHVILLE FAMILY DENTISTRY LLC

Agent

Name Role
JORDAN, JASON B Agent

Member

Name Role
JORDAN, JASON B Member

Events

Event Date Event Type Old Value New Value
2004-05-06 Name Change Lincoln Family Dentistry, LLC Ashville Family Dentistry, LLC

Related by officers

No related officers

Related by address

BIRMINGHAM, AL

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Date of last update: 15 Aug 2024

Sources: Alabama Secretary of State

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