| Name: | Sand Mountain Family Dentistry LLC. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Limited Liability Company |
| Status: | Exists |
| Date of registration: | 07 May 2021 (4 years ago) (Companies founded in May 2021) |
| Entity Number: | 000-854-512 |
| Register Number: | 000854512 |
| ZIP code: | 35901 (Companies in Etowah, 35901) |
| County: | Etowah |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 211 Dogwood CircleGadsden, AL 35901 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790367126 | 2021-04-26 | 2021-05-19 | 211 DOGWOOD CIR, GADSDEN, AL, 359015601, US | 701 MEDICAL CENTER PKWY, BOAZ, AL, 359575938, US | |||||||||||||||||||
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| Phone | +1 205-467-0387 |
Authorized person
| Name | DR. BRANT HAYNIE |
| Role | OWNER/DENTIST |
| Phone | 2054670387 |
Taxonomy
| Taxonomy Code | 261QD0000X - Dental Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 171653 |
| State | AL |
| Name | Role |
|---|---|
| Haynie, Brant D Haynie | Agent |
| Name | Role | Address |
|---|---|---|
| HAYNIE DENTAL MANAGEMENT, INC. | Organizer | 211 DOGWOOD CIRCLEGADSDEN, AL 35901 |
| POWELL INVESTMENTS, LLC | Organizer | 5713 MACON DRIVEHUNTSVILLE, AL 35802 |
Date of last update: 16 Aug 2024
Sources: Alabama Secretary of State
