| Name: | Chickasaw Family Dental, PLLC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Exists |
| Date of registration: | 28 Jan 2021 (4 years ago) |
| Entity Number: | 000-832-525 |
| Register Number: | 000832525 |
| County: | Montgomery |
| Place of Formation: | Mississippi |
| Registered Office Street Address: | 2 North Jackson Street, Suite 605Montgomery, AL 36104 |
| Registered Office Street Address ZIP Code: | 36104 |
| Principal Address: | 4358 Lincoln Road Extension, Suite 2Hattiesburg, MS 39402 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316530736 | 2021-02-17 | 2021-10-14 | 457 N CRAFT HWY, CHICKASAW, AL, 366111364, US | 457 N CRAFT HWY, CHICKASAW, AL, 366111364, US | |||||||||||||
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| Phone | +1 251-456-8406 |
Authorized person
| Name | LANTHEA MANGUM |
| Role | COO |
| Phone | 6012718710 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
| Name | Role |
|---|---|
| C T Corporation System | Agent |
Date of last update: 16 Aug 2024
Sources: Alabama Secretary of State
