| Name: | Birmingham Family Dental Services, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 03 Jun 2003 (21 years ago) |
| Entity Number: | 000-690-619 |
| Register Number: | 000690619 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 707 RICHARD ARRINGTON JR BLVD NBIRMINGHAM, AL 35233 |
| Registered Office Street Address ZIP Code: | 35233 |
Activities
ANY LAWFUL ACTIVITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447363387 | 2006-08-16 | 2008-06-13 | 707 RICHARD ARRINGTON JR BLVD S, BIRMINGHAM, AL, 352332105, US | 707 RICHARD ARRINGTON JR BLVD S, BIRMINGHAM, AL, 352332105, US | |||||||||||||||||||||||||
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| Phone | +1 205-251-8128 |
| Fax | 2052518188 |
Authorized person
| Name | DR. HENRY GRADY SWICORD |
| Role | DOCTOR |
| Phone | 2052518128 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 4051 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009904825 |
| State | AL |
| Name | Role |
|---|---|
| SWICORD, H GRADY | Agent |
| Name | Role |
|---|---|
| SWICORD, H GRADY | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
